1
|
Di Marco F, Cusini C, Ferrulli A, Mauri G, Luzi L. Post-surgical Persistent Hyperparathyroidism Successfully Treated with Parathyroid Radiofrequency Ablation: A Case Report. Endocr Metab Immune Disord Drug Targets 2024; 24:EMIDDT-EPUB-140007. [PMID: 38676523 DOI: 10.2174/0118715303308277240419062634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/27/2024] [Accepted: 04/02/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Currently, parathyroidectomy is the standard treatment for Primary Hyperparathyroidism (PHPT). Surgical treatment is often effective, although not free of complications and relapses. Minimally invasive techniques, such as Microwave Ablation (MWA) and Radiofrequency Ablation (RFA), are an alternative to surgery in selected patients. We have, herein, reported on the successful use of RFA in a patient with post-surgical persistent hyperparathyroidism. CASE PRESENTATION A 54-year-old woman was referred to our Center for mild hypercalcemia with exams revealing Primary Hyperparathyroidism (PHPT). Neck ultrasound and Technetium- 99 Methoxy-isobutyl-isonitrile (99mTc-MIBI) scintigraphy scanning revealed a suspicious right parathyroid hyperplasia/adenoma. She underwent parathyroidectomy and histological examination showed a parathyroid nodular hyperplasia. During the follow-up, she suffered from persistent hyperparathyroidism due to the treatment of left parathyroid hypoplasia with RFA. Blood tests after the procedure showed the remission of the disease 7 months post-treatment. CONCLUSION A minimally invasive technique for PHPT may represent a valid alternative to surgery, especially in patients with an elevated surgery-related risk. More studies are necessary to investigate the benefit of RFA as a first-line treatment in PHPT.
Collapse
Affiliation(s)
- Francesco Di Marco
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Claudio Cusini
- Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS Multi Medica, Sesto San Giovanni (MI), Italy
| | - Anna Ferrulli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
- Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS Multi Medica, Sesto San Giovanni (MI), Italy
| | - Giovanni Mauri
- Division of Interventional Radiology, IEO, European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Livio Luzi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
- Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS Multi Medica, Sesto San Giovanni (MI), Italy
| |
Collapse
|
2
|
Czigléczki G, Berényi G. [Ultrasound-guided decompression in the treatment of carpal tunnel syndrome]. Orv Hetil 2024; 165:346-350. [PMID: 38431905 DOI: 10.1556/650.2024.32989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 12/27/2023] [Indexed: 03/05/2024]
Abstract
Bevezetés: A kéztőalagút-szindróma hazánkban is gyakran
előforduló megbetegedés, akár minden 10. embert érintheti. Korai tüneteinek
felismerése elengedhetetlen az időben történő diagnózishoz és a beavatkozáshoz.
Súlyos vagy konzervatív kezelésekre nem reagáló esetekben sebészeti beavatkozás
válhat szükségessé. Célkitűzés: A jelen közlemény célja egy
hazánkban újonnan meghonosított, ultrahangvezérelt dekompressziós műtét
bemutatása és eredményeinek taglalása. Módszer: A műtét
egynapos sebészeti ellátás keretében történik, lokális érzéstelenítésben.
Ultrahang segítségével azonosítjuk a medianus ideg lefutását, a fontosabb
érképleteket, biztonsági határokat. 2 mm-es bőrmetszésen keresztül folyamatos
ultrahangkontroll alatt vezetjük be a műtéti eszközöket. A sarlós szikével
alulról metsszük át a ligamentum carpi transversumot, így dekomprimálva a
medianus ideget. A teljes dekompressziót igazoljuk ultrahanggal és
segédeszközökkel is. A sebet a legtöbb esetben ragasztjuk.
Eredmények: A módszert 44 beteg esetében végeztük 2022.
október és 2023. november között. A műtétet megelőzően minden esetben
ultrahangvizsgálat is történt a szekunder okok és a kontraindikáló tényezők
(például egyedi éranatómia) kizárására. Műtéti indikációnak az
elektrofiziológiailag igazolt, közepes vagy súlyos fokú idegi károsodást,
továbbá a betegek által jelzett, az életminőséget jelentősen rontó, tűrhetetlen
panaszokat tekintettük. Intraoperatív vagy major komplikációt egyetlen esetben
sem tapasztaltunk. 2 esetben jelentkezett kisebb komplikáció (bőrpír, hosszabb
gyógyulás a kéz túl korai erőltetése miatt). A betegek már a műtétet követő 2.
naptól a tünetek jelentős csökkenését tapasztalták, és az operált kezüket a
mindennapokban használhatták. A zsibbadásos panaszok megszűnése átlagosan 2,5
hét alatt következett be. Következtetés: Az ultrahangvezérelt
dekompresszió kiváló és biztonságos lehetőséget nyújt a kéztőalagút-szindróma
minimálisan invazív kezelésére. A technika fő előnyei közül kiemelhető az apró
vágásból származó kisebb fokú hegesedés, valamint a rövid ideig tartó
rehabilitáció és munkába való gyors visszatérés lehetősége. Orv Hetil. 2024;
165(9): 346–350.
Collapse
Affiliation(s)
| | - György Berényi
- 1 Szent Magdolna Magánkórház Budapest Magyarország
- 2 Országos Mentális, Ideggyógyászati és Idegsebészeti Intézet Budapest Magyarország
| |
Collapse
|
3
|
Chula DC, Riella MC, Portiolli Franco R, de Alcântara MT, Campos RP, Gordon GM, Rokukawa PE, do Nascimento MM. Minimally invasive peritoneal access: A new approach of catheter placement for peritoneal dialysis. J Vasc Access 2024; 25:557-565. [PMID: 36203380 DOI: 10.1177/11297298221127756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Catheter implantation techniques for peritoneal dialysis (PD) have advanced significantly in recent years. We aimed to analyze the survival and associated complications of catheters inserted using a new technique that is guided by ultrasound and fluoroscopy and requires minimal tissue dissection. The procedure was performed by nephrologists in the outpatient basis, we compared these results of the minimally invasive insertion with traditional implantation using trocars. METHODS A total of 152 PD catheters were placed in 152 patients with stage 5 chronic kidney disease; 62.5% of the patients were men, with a mean age of 56.6 ± 18.5 years. The following two methods were used: minimally invasive insertion (MI group, n = 73) and trocar insertion (T group, n = 79). Patients in both the groups were followed prospectively for 26 months from the date of the first implantation. RESULTS Gender, age, and prevalence of diabetes mellitus were not significantly different between the groups, while the body mass index, presence of obesity, and abdominal scars from previous surgeries were higher in the MI group (p = 0.021). The incidence of catheter dysfunction was lower in the MI group compared to group T (6.8% vs 20.3%; p = 0.019). Exit site infection was also lower with the new technique (4.1% vs. 18.9%; p = 0.005). Further, the cumulative incidence of peritonitis also reduced with MI (p = 0.034). Finally, the overall catheter survival at 1 year was 89%, which has been shown as higher in group MI (95% vs 82% in group T; p = 0.025). CONCLUSION The MI technique for catheter insertion showed low complication rates and excellent catheter survival as compared to traditional implantation methods; thus, it may be an alternative method for PD catheter placement.
Collapse
Affiliation(s)
- Domingos Candiota Chula
- Pro Renal Foundation Brazil, Curitiba, Paraná, Brazil
- Hospital de Clínicas Complex-Federal University of Paraná, Curitiba, Paraná, Brazil
- Postgraduate Program in Internal Medicine and Health Sciences of the Federal University of Paraná, Curitiba, Paraná, Brazil
| | | | | | - Márcia Tokunaga de Alcântara
- Pro Renal Foundation Brazil, Curitiba, Paraná, Brazil
- Hospital de Clínicas Complex-Federal University of Paraná, Curitiba, Paraná, Brazil
| | | | | | | | - Marcelo Mazza do Nascimento
- Pro Renal Foundation Brazil, Curitiba, Paraná, Brazil
- Hospital de Clínicas Complex-Federal University of Paraná, Curitiba, Paraná, Brazil
- Postgraduate Program in Internal Medicine and Health Sciences of the Federal University of Paraná, Curitiba, Paraná, Brazil
| |
Collapse
|
4
|
Byvaltsev VA, Kalinin AA. [Minimally invasive removal of dumbbell shaped schwannomas with transforaminal lumbar fusion: a retrospective study with a minimum 3-year follow-up]. Zh Vopr Neirokhir Im N N Burdenko 2024; 88:47-53. [PMID: 38549410 DOI: 10.17116/neiro20248802147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Currently, there are no standards in surgical treatment of dumbbell-shaped tumors of lumbo-foraminal region. OBJECTIVE To evaluate the effectiveness and long-term results of minimally invasive resection of dumbbell-shaped lumbar schwannomas Eden type 2 and 3 combined with transforaminal lumbar interbody fusion and transpedicular stabilization. MATERIAL AND METHODS A retrospective study included 13 patients (8 men and 5 women) with lumbar dumbbell tumors Eden type 2 and 3 who underwent minimally invasive facetectomy through posterolateral anatomical corridor, microsurgical tumor resection and MI TLIF. We analyzed intraoperative parameters, neurological functions (ASIA scale), clinical characteristics (ODI, SF-36), and complications. Resection quality and area of the multifidus muscle were assessed according to MRI data. All patients were followed-up throughout at least 3-year. RESULTS Surgery time was 147 min, blood loss - 118 ml, hospital-stay - 7 days. Clinical parameters significantly improved in the follow-up period: ODI score decreased from 72 to 12 (p=0.004), SF-36 PCS increased from 26.24 to 48.51 (p=0.006) and MCS score increased from 29.13 to 53.68 (p=0.002). According to MRI data, no tumor recurrences and severe muscle atrophy (>30%) were observed after 3 years in all cases. Superficial wound infection occurred in 1 (7.7%) case. There were normal neurological functions (ASIA type E) in all patients. CONCLUSION Minimally invasive facetectomy through posterolateral approach with MI TLIF technology can be used for safe and effective resection of dumbbell-shaped schwannomas Eden type 2 and 3.
Collapse
Affiliation(s)
- V A Byvaltsev
- Irkutsk State Medical University, Irkutsk, Russia
- Russian Railways-Medicine Clinical Hospital, Irkutsk, Russia
- Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia
| | - A A Kalinin
- Irkutsk State Medical University, Irkutsk, Russia
- Russian Railways-Medicine Clinical Hospital, Irkutsk, Russia
| |
Collapse
|
5
|
Ohba T, Oda K, Tanaka N, Haro H. The Utility and Appropriateness of Single-Position Circumferential Lumbar Interbody Fusion Using O-Arm-Based Navigation in the Novel Oblique Position. J Clin Med 2023; 12:7114. [PMID: 38002728 PMCID: PMC10672567 DOI: 10.3390/jcm12227114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 11/12/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
PURPOSE Single-position surgery with patients in a lateral position, which involves inserting percutaneous pedicular screws (PPS) and lateral interbody fusion (LIF) to avoid changing the position, has been reported. The purpose of the present study was to evaluate the utility and appropriateness of single-position LIF-PPS using O-arm-based navigation in the innovative oblique position. METHODS This study involved a retrospective analysis of 92 consecutive patients with lumbar spondylolisthesis who underwent LIF-PPS using O-arm-based navigation. Thirty-five subjects demonstrated surgery with repositioning, as well as 24 in the lateral decubitus position, and 33 in the oblique during PPS, where the position was changed to the lateral decubitus position using bed rotation without resetting. We compared these three groups in terms of the surgery time, blood loss, and the accuracy of the screw placement. RESULTS The operative time was significantly shorter in the single-position surgery, both in the lateral and oblique positions, compared to surgery in a dual position. The blood loss was significantly increased in the lateral position compared to the dual and oblique positions. The screw trajectory angle on the downside was significantly smaller in the lateral position, and the accuracy of the screw placement on the downside was significantly lower in the lateral position compared to the dual and oblique positions. CONCLUSION Single-position surgery could reduce the average surgery time by about 60 min. The present study indicated the oblique position during PPS insertion might make single-position surgery more useful to improve the accuracy of PPS on the downside, with less blood loss.
Collapse
Affiliation(s)
- Tetsuro Ohba
- Department of Orthopaedic Surgery, University of Yamanashi, 1110, Shimokato, Chuo, Yamanashi 409-3898, Japan; (K.O.); (N.T.); (H.H.)
| | | | | | | |
Collapse
|
6
|
鲁 圣, 谈 美, 孙 强, 匡 延. [Clinical study on a novel minimally invasive Achilles tendon suture instrument for treating fresh closed Achilles tendon rupture]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2023; 37:1062-1067. [PMID: 37718416 PMCID: PMC10505638 DOI: 10.7507/1002-1892.202305054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/01/2023] [Accepted: 08/01/2023] [Indexed: 09/19/2023]
Abstract
Objective To assess the effectiveness of a novel minimally invasive Achilles tendon suture instrument in the treatment of fresh closed Achilles tendon rupture. Methods A retrospective study was conducted on 150 patients who underwent surgical intervention for fresh closed Achilles tendon rupture. Eighty patients were treated with the novel minimally invasive Achilles tendon suture instrument (minimally invasive group) and 70 patients with traditional open surgery (traditional group). The two groups were comparable in terms of gender, age, injured side, cause of injury, the interval between injury and operation, and the distance from the fracture end to the calcaneal tuberosity ( P>0.05). The operation time, intraoperative blood loss, incision length, hospital stays, hospitalization expenses, and complications were recorded and compared. At 1 year after operation, the ankle joint function was evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score. Results The minimally invasive group demonstrated significantly shorter operation time, smaller incision length, and lower intraoperative blood loss when compared with the traditional group ( P<0.05). However, there was no significant difference in terms of hospital stays and hospitalization expenses between the two groups ( P>0.05). All patients were followed up 12-24 months after operation (mean, 15.5 months). In the traditional group, 6 cases of incision necrosis and 7 cases of Achilles tendon adhesion occurred, while in the minimally invasive group, all incisions healed at first intention and no Achilles tendon adhesion occurred. The differences in the incidences of the two complications between the two groups were significant ( P<0.05). At 1 year after operation, the AOFAS ankle-hindfoot score in the minimally invasive group was superior to that of the traditional group ( P<0.05). Conclusion In comparison with traditional open surgery, the use of self-designed novel minimally invasive Achilles tendon suture instrument proves to be an ideal technique for treating fresh closed Achilles tendon ruptures. This approach offers the benefits of smaller incisions, fewer complications, and better postoperative functional recovery, without increasing hospital costs.
Collapse
Affiliation(s)
- 圣助 鲁
- 武汉科技大学附属武昌医院骨科(武汉 430063)Department of Orthopaedics, Wuchang Hospital Affiliated to Wuhan University of Science and Technology, Wuhan Hubei, 430063, P. R. China
| | - 美娟 谈
- 武汉科技大学附属武昌医院骨科(武汉 430063)Department of Orthopaedics, Wuchang Hospital Affiliated to Wuhan University of Science and Technology, Wuhan Hubei, 430063, P. R. China
| | - 强 孙
- 武汉科技大学附属武昌医院骨科(武汉 430063)Department of Orthopaedics, Wuchang Hospital Affiliated to Wuhan University of Science and Technology, Wuhan Hubei, 430063, P. R. China
| | - 延顺 匡
- 武汉科技大学附属武昌医院骨科(武汉 430063)Department of Orthopaedics, Wuchang Hospital Affiliated to Wuhan University of Science and Technology, Wuhan Hubei, 430063, P. R. China
| |
Collapse
|
7
|
Aprigliano G, Giupponi L, Palloshi A, Glavina F, Morici N. Sheathless use of Supera stent minimizes access complications in antegrade femoral puncture: Technical note with case series. J Vasc Access 2023; 24:1180-1184. [PMID: 34911390 DOI: 10.1177/11297298211050480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Antegrade femoral puncture (AFP) is the preferred strategy to treat lower limb obstructive disease. However, the presence of vascular calcification may be associated with procedure related adverse events, impairing endovascular device strategies. We describe a case series of superficial femoral and popliteal artery treatments by Supera stent implantation using a simple technique to significantly minimize the dimension of the antegrade femoral puncture from 6 to 4 French (Fr). All antegrade femoral punctures, crossing femoro-popliteal lesion and predilation were made with 4 Fr introducer. After preparation the Supera stent was navigated in sheathless fashion via 0.018-inch guidewire. Postdilation and final control were made replacing the 4 Fr introducer via the same guidewire. A good final result was achieved. Patients were discharged early without any complications. This minimally invasive technique in cases of infrainguinal peripheral artery disease could be feasible and effective for minimizing the risk of complications in patients with critical limb ischemia.
Collapse
Affiliation(s)
| | - Luca Giupponi
- Interventional Cardiovascular Unit, Istituto Clinico Città Studi, Milan, Italy
| | - Altin Palloshi
- Interventional Cardiovascular Unit, Istituto Clinico Città Studi, Milan, Italy
| | - Fabio Glavina
- Interventional Cardiovascular Unit, Istituto Clinico Città Studi, Milan, Italy
| | - Nuccia Morici
- Unità di Cure Intensive Cardiologiche, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| |
Collapse
|
8
|
Nakabori T, Abe Y, Higashi S, Mukai K, Shingetsu A, Nishimura S, Tsuzaki S, Ryu A, Tanada S, Nagata S, Honma K, Ohkawa K. Sensitivity of cytology in liver tumor biopsy and its significance in the prompt clinical diagnosis of non-hepatocellular carcinoma. Cancer Med 2023. [PMID: 37062058 DOI: 10.1002/cam4.5934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/31/2023] [Accepted: 04/03/2023] [Indexed: 04/17/2023] Open
Abstract
BACKGROUND Cytology is a fast and simple modality for identifying malignancies and tumor histology. In this study, we analyzed the sensitivity of cytology for liver tumor biopsy and evaluated its potential for prompt clinical diagnosis. METHODS This retrospective study included patients who had concurrently undergone conventional cytology, on-site cytology, and histopathology for ultrasound-guided liver tumor biopsies. In the case of malignant tumors, malignancy was first diagnosed, then preliminary clinical diagnosis was established using histology based on cytology and clinical information, followed by histopathological diagnosis. Sensitivity of malignancy detection was evaluated by comparison with histopathological diagnosis. RESULTS Of the 191 tumors, 164 (85.9%) were malignant. The sensitivity of conventional cytology for malignancy detection was 97.6%. The sensitivity of non-hepatocellular carcinoma (non-HCC) (99.3%) detection was higher than that of the HCCs (87.5%; p = 0.001). The sensitivity of on-site cytology for malignancy detection was as high as that of conventional cytology. Similar to conventional cytology, the sensitivity of on-site cytology for non-HCC detection (99.3%) was higher than that for HCCs (79.2%; p < 0.001). In most cases of non-HCC tumors (126/140, 90.0%), accurate preliminary clinical diagnoses were obtained by combining on-site cytology with clinical information. CONCLUSION Cytology of liver tumor biopsy has high sensitivity for malignancy, especially in non-HCC tumors. On-site cytology can contribute to the prompt clinical diagnosis of non-HCC tumors when combined with clinical information. This approach may be a reassuring modality for patients with severely advanced cancers requiring prompt clinical diagnosis and quick initiation of treatment owing to their deteriorating health.
Collapse
Affiliation(s)
- Tasuku Nakabori
- Department of Hepatobiliary and Pancreatic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yutaro Abe
- Department of Hepatobiliary and Pancreatic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Sena Higashi
- Department of Hepatobiliary and Pancreatic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Kaori Mukai
- Department of Hepatobiliary and Pancreatic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Azusa Shingetsu
- Department of Clinical Laboratory, Osaka International Cancer Institute, Osaka, Japan
| | - Sanako Nishimura
- Department of Clinical Laboratory, Osaka International Cancer Institute, Osaka, Japan
| | - Sayoko Tsuzaki
- Department of Clinical Laboratory, Osaka International Cancer Institute, Osaka, Japan
| | - Ayumi Ryu
- Department of Clinical Laboratory, Osaka International Cancer Institute, Osaka, Japan
| | - Satoshi Tanada
- Department of Clinical Laboratory, Osaka International Cancer Institute, Osaka, Japan
| | - Shigenori Nagata
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
| | - Keiichiro Honma
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
| | - Kazuyoshi Ohkawa
- Department of Hepatobiliary and Pancreatic Oncology, Osaka International Cancer Institute, Osaka, Japan
| |
Collapse
|
9
|
Arocho-Quinones EV, Lew SM, Handler MH, Tovar-Spinoza Z, Smyth MD, Bollo RJ, Donahue D, Perry MS, Levy M, Gonda D, Mangano FT, Kennedy BC, Storm PB, Price AV, Couture DE, Oluigbo C, Duhaime AC, Barnett GH, Muh CR, Sather MD, Fallah A, Wang AC, Bhatia S, Eastwood D, Tarima S, Graber S, Huckins S, Hafez D, Rumalla K, Bailey L, Shandley S, Roach A, Alexander E, Jenkins W, Tsering D, Price G, Meola A, Evanoff W, Thompson EM, Brandmeir N. Magnetic resonance imaging-guided stereotactic laser ablation therapy for the treatment of pediatric epilepsy: a retrospective multiinstitutional study. J Neurosurg Pediatr 2023:1-14. [PMID: 36883640 PMCID: PMC10193482 DOI: 10.3171/2022.12.peds22282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 12/30/2022] [Indexed: 03/09/2023]
Abstract
OBJECTIVE The authors of this study evaluated the safety and efficacy of stereotactic laser ablation (SLA) for the treatment of drug-resistant epilepsy (DRE) in children. METHODS Seventeen North American centers were enrolled in the study. Data for pediatric patients with DRE who had been treated with SLA between 2008 and 2018 were retrospectively reviewed. RESULTS A total of 225 patients, mean age 12.8 ± 5.8 years, were identified. Target-of-interest (TOI) locations included extratemporal (44.4%), temporal neocortical (8.4%), mesiotemporal (23.1%), hypothalamic (14.2%), and callosal (9.8%). Visualase and NeuroBlate SLA systems were used in 199 and 26 cases, respectively. Procedure goals included ablation (149 cases), disconnection (63), or both (13). The mean follow-up was 27 ± 20.4 months. Improvement in targeted seizure type (TST) was seen in 179 (84.0%) patients. Engel classification was reported for 167 (74.2%) patients; excluding the palliative cases, 74 (49.7%), 35 (23.5%), 10 (6.7%), and 30 (20.1%) patients had Engel class I, II, III, and IV outcomes, respectively. For patients with a follow-up ≥ 12 months, 25 (51.0%), 18 (36.7%), 3 (6.1%), and 3 (6.1%) had Engel class I, II, III, and IV outcomes, respectively. Patients with a history of pre-SLA surgery related to the TOI, a pathology of malformation of cortical development, and 2+ trajectories per TOI were more likely to experience no improvement in seizure frequency and/or to have an unfavorable outcome. A greater number of smaller thermal lesions was associated with greater improvement in TST. Thirty (13.3%) patients experienced 51 short-term complications including malpositioned catheter (3 cases), intracranial hemorrhage (2), transient neurological deficit (19), permanent neurological deficit (3), symptomatic perilesional edema (6), hydrocephalus (1), CSF leakage (1), wound infection (2), unplanned ICU stay (5), and unplanned 30-day readmission (9). The relative incidence of complications was higher in the hypothalamic target location. Target volume, number of laser trajectories, number or size of thermal lesions, or use of perioperative steroids did not have a significant effect on short-term complications. CONCLUSIONS SLA appears to be an effective and well-tolerated treatment option for children with DRE. Large-volume prospective studies are needed to better understand the indications for treatment and demonstrate the long-term efficacy of SLA in this population.
Collapse
Affiliation(s)
- Elsa V. Arocho-Quinones
- Departments of Neurosurgery and
- Department of Neurosurgery, Children’s Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Sean M. Lew
- Departments of Neurosurgery and
- Department of Neurosurgery, Children’s Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Michael H. Handler
- Department of Neurosurgery, Children’s Hospital Colorado, Aurora, Colorado
| | - Zulma Tovar-Spinoza
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York
| | - Matthew D. Smyth
- Division of Neurosurgery, Johns Hopkins All Children’s Hospital, St. Petersburg, Florida
| | - Robert J. Bollo
- Department of Neurosurgery, Primary Children’s Hospital, Salt Lake City, Utah
| | | | - M. Scott Perry
- Neurology, Cook Children’s Medical Center, Fort Worth, Texas
| | - Michael Levy
- Department of Neurosurgery, Rady Children’s Hospital San Diego, San Diego, California
| | - David Gonda
- Department of Neurosurgery, Rady Children’s Hospital San Diego, San Diego, California
| | | | - Benjamin C. Kennedy
- Department of Neurosurgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Phillip B. Storm
- Department of Neurosurgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Angela V. Price
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Daniel E. Couture
- Department of Neurosurgery, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Chima Oluigbo
- Department of Neurosurgery, Children’s National Health System, Washington, DC
| | | | - Gene H. Barnett
- Department of Neurosurgery, Cleveland Clinic Children’s, Cleveland, Ohio
| | - Carrie R. Muh
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
- Department of Neurosurgery, Maria Fareri Children’s Hospital, Valhalla, New York
| | - Michael D. Sather
- Department of Neurosurgery, Penn State Health, Hershey, Pennsylvania
| | - Aria Fallah
- Department of Neurosurgery, UCLA Mattel Children’s Hospital, Los Angeles, California
| | - Anthony C. Wang
- Department of Neurosurgery, UCLA Mattel Children’s Hospital, Los Angeles, California
| | - Sanjiv Bhatia
- Department of Neurosurgery, Nicklaus Children’s Hospital, Miami, Florida
| | - Daniel Eastwood
- Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sergey Tarima
- Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sarah Graber
- Department of Neurosurgery, Children’s Hospital Colorado, Aurora, Colorado
| | - Sean Huckins
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York
| | - Daniel Hafez
- Department of Neurosurgery, St. Louis Children’s Hospital, St. Louis, Missouri; and
| | - Kavelin Rumalla
- Department of Neurosurgery, St. Louis Children’s Hospital, St. Louis, Missouri; and
| | | | | | - Ashton Roach
- Department of Neurosurgery, Cincinnati Children’s Hospital, Cincinnati, Ohio
| | - Erin Alexander
- Department of Neurosurgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Wendy Jenkins
- Department of Neurosurgery, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Deki Tsering
- Department of Neurosurgery, Children’s National Health System, Washington, DC
| | - George Price
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Antonio Meola
- Department of Neurosurgery, Cleveland Clinic Children’s, Cleveland, Ohio
| | - Wendi Evanoff
- Department of Neurosurgery, Cleveland Clinic Children’s, Cleveland, Ohio
| | - Eric M. Thompson
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | | | - for the Pediatric Stereotactic Laser Ablation Workgroup
- Departments of Neurosurgery and
- Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
- Department of Neurosurgery, University of Texas at Austin/Dell Medical School, Austin, Texas
- Department of Neurosurgery, Children’s Hospital of Wisconsin, Milwaukee, Wisconsin
- Department of Neurosurgery, Children’s Hospital Colorado, Aurora, Colorado
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York
- Division of Neurosurgery, Johns Hopkins All Children’s Hospital, St. Petersburg, Florida
- Department of Neurosurgery, Primary Children’s Hospital, Salt Lake City, Utah
- Departments of Neurosurgery and
- Neurology, Cook Children’s Medical Center, Fort Worth, Texas
- Department of Neurosurgery, Rady Children’s Hospital San Diego, San Diego, California
- Department of Neurosurgery, Cincinnati Children’s Hospital, Cincinnati, Ohio
- Department of Neurosurgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Neurosurgery, Wake Forest Baptist Health, Winston-Salem, North Carolina
- Department of Neurosurgery, Children’s National Health System, Washington, DC
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
- Department of Neurosurgery, Cleveland Clinic Children’s, Cleveland, Ohio
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
- Department of Neurosurgery, Penn State Health, Hershey, Pennsylvania
- Department of Neurosurgery, UCLA Mattel Children’s Hospital, Los Angeles, California
- Department of Neurosurgery, Nicklaus Children’s Hospital, Miami, Florida
- Department of Neurosurgery, St. Louis Children’s Hospital, St. Louis, Missouri; and
- Department of Neurosurgery, Maria Fareri Children’s Hospital, Valhalla, New York
| |
Collapse
|
10
|
Wolff S, Moreau PE, Miladi L, Riouallon G. Is Minimally Invasive Bipolar Technique a Better Alternative to Long Fusion for Adult Neuromuscular Scoliosis? Global Spine J 2023:21925682231159347. [PMID: 36809191 DOI: 10.1177/21925682231159347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVES To report the results for an alternative technique based on minimally invasive fusion-less surgery. This approach is original in that it corrects deformities by proximal and distal fixation, with reliable pelvic fixation through the use of iliosacral screws on osteoporotic bones. METHODS Adult cerebral palsy patients requiring spinal correction surgery were included prospectively between 2015 and 2019. The technique involved the use of a double-rod construct anchored proximally by four clawed hooks and distally by iliosacral screws, in a minimally invasive approach. Cobb angle and pelvic obliquity were measured before and after initial surgery and at final follow-up. Complications and functional results were reviewed. This group (P) was compared with a second group (R) of patients who underwent surgery between 2005 and 2015, for whom data were collected retrospectively. RESULTS Thirty-one patients were included in group P, and 15 in group R. The two groups were comparable for demographic data and deformity. At most recent follow-up (3 years for group P [2-6] and 5 years for group R [2-16]), neither correction nor surgical complications differed between the two groups. However, group P had 50% less blood loss and a lower medical complication rate than group R. CONCLUSIONS Our results confirm the effectiveness of this minimally invasive technique for neuromuscular scoliosis in adults. The results were similar to those obtained with the usual techniques, but with fewer medical complications. Confirmation of these results is now required for a longer follow-up period.
Collapse
Affiliation(s)
- Stéphane Wolff
- Service de Chirurgie Orthopédique, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | | | - Lotfi Miladi
- Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades, Paris, France
| | - Guillaume Riouallon
- Service de Chirurgie Orthopédique, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| |
Collapse
|
11
|
Yin JH, Chen YH, Ren YB, Wang R, Su S, Jiang EL, Li YB, Wang T, Xiao WD, Du GS. Feasibility and preliminary experience of single-incision plus one-port laparoscopic total gastrectomy with Overlap esophagojejunostomy for gastric cancer: A study of 10 cases. Front Surg 2023; 9:1071363. [PMID: 36700036 PMCID: PMC9869672 DOI: 10.3389/fsurg.2022.1071363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
Background This study aimed to explore the feasibility and safety of single-incision plus one-port laparoscopic total gastrectomy (SITG + 1) with Overlap esophagojejunostomy (SITG + 1-Overlap) and to share preliminary experiences. Methods This retrospective study included 10 patients with gastric cancer located in the cardia or body who underwent SITG + 1-Overlap between August 2020 and October 2021.The demographics, tumor characteristics, postoperative outcomes, and short-term complications of all the enrolled patients were summarized and statistically analyzed. Data were expressed as mean ± standard deviation (SD) if they were normally distributed. Otherwise, Median (Quartile1, Quartile3) was used. Results In the collective perioperative data of these 10 patients who underwent radical gastrectomy, the median of the length of transumbilical incision and blood loss were 3.0 cm and 100.0 ml respectively, and the mean operation time and 385.5 ± 51.6 min. Postoperative data indicated that the gastric tube was removed on 2.0 (2.0, 3.0) days, and the timing of first feeding, activity, flatus, and defecation was 1.5 (1.0, 2.0) days, 2.0 (2.0, 2.0) days, 3.0 (2.0, 3.0) days, and 3.8 ± 0.6 days, respectively. The timing of drainage tube removal was 4.6 ± 1.0 days after operation. The duration of hospital stay was 7.5 ± 1.2 days and the VAS pain scores for the 3 days following surgery were 3.0 (2.0, 3.3), 2.0 (2.0, 3.0), and 1.5 (1.0, 2.0) respectively. The mean number of retrieved lymph nodes was 30.7 ± 13.2. Most biochemical indicators gradually normalized with the recovery of the patients after surgery. No 30-day postoperative complications were noted. Conclusions For the first time, our preliminary data indicate the feasibility and safety of Overlap esophagojejunostomy in SITG + 1 surgery. This modified Overlap procedure has the potential to simplify the reconstruction procedure and lower the technical challenge of SITG + 1 radical gastrectomy for cardia or upper gastric cancer in the early and advanced stages.
Collapse
Affiliation(s)
- Jiu-Heng Yin
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yi-Hui Chen
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yan-Bei Ren
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Rong Wang
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Shuai Su
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - En-Lai Jiang
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yun-Bo Li
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Ting Wang
- Nursing Department, Nursing School of Chongqing Medical and Pharmaceutical College, Chongqing, China
| | - Wei-Dong Xiao
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China,Correspondence: Wei-Dong Xiao Guang-Sheng Du
| | - Guang-Sheng Du
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China,Correspondence: Wei-Dong Xiao Guang-Sheng Du
| |
Collapse
|
12
|
Kataoka Y, Kojima Y, Ishibashi R, Nakao Y, Yamamura K, Takahashi S, Hashiba T, Matsue T. Transoral removal of a hilo-parenchymal submandibular sialolith. Clin Case Rep 2022; 10:e05903. [PMID: 35664512 PMCID: PMC9137105 DOI: 10.1002/ccr3.5903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/15/2022] [Accepted: 04/19/2022] [Indexed: 11/15/2022] Open
Abstract
In sialolithiasis, the lithiasis is often large and located at the junction of the middle and posterior third of the duct, in the hilum region. In such cases, transoral approach for submandibular lithiases (TASL) is a useful treatment of choice in patients with large submandibular stones that can be palpated bimanually.
Collapse
Affiliation(s)
| | | | | | - Yuji Nakao
- Self‐Defence Forces Central HospitalSetagaya‐kuJapan
| | - Koji Yamamura
- Self‐Defence Forces Central HospitalSetagaya‐kuJapan
| | | | | | | |
Collapse
|
13
|
Stake IK, Miles JW, Douglass BW, Dornan GJ, Clanton TO. Biomechanical Evaluation of Achilles Tendon Midsubstance Repair: The Effects of Anchor Angle and Position. Foot Ankle Spec 2022; 15:67-75. [PMID: 34142573 DOI: 10.1177/19386400211009360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The percutaneous knotless repair technique for Achilles tendon ruptures utilizes a Percutaneous Achilles Repair System (PARS) device for suturing the proximal tendon and 2 suture anchors for fixing the sutures into the calcaneus. Determining the best position of the suture anchors may optimize the strength of this repair. METHODS Twelve pairs of human ankle cadaveric specimens were randomly assigned to receive suture anchors placed at 45°, 90°, or 135° from the sagittal plane. The anchors were tensioned according to a protocol representing progressive, postoperative rehabilitation. Load, number of loading cycles, displacement, and mode of failure were recorded. RESULTS With the anchors placed at 45°, 90°, and 135°, the ultimate failure loads were mean 265 ± 64 N, 264 ± 75 N, and 279 ± 40 N, and the total number of loading cycles were mean 459 ± 166, 466 ± 158, and 469 ± 110, respectively. The effect of anchor angle on failure load, number of loading cycles, and displacement was not statistically significant. Visually, the anchors at 45° and 90° demonstrated sutures cutting through the bone. CONCLUSION We found no statistically significant difference in pullout strength between the 3 different anchor angles. Sutures cutting through the bone may be a concern with acute anchor angles. This suggests that a 135° anchor angle may result in a lower risk of tendon elongation with the percutaneous knotless repair technique. LEVELS OF EVIDENCE Cadaveric laboratory study.
Collapse
Affiliation(s)
- Ingrid K Stake
- Steadman Philippon Research Institute, Vail, Colorado.,Department of Orthopedic Surgery, Østfold Hospital Trust, Grålum, Norway
| | - Jon W Miles
- Steadman Philippon Research Institute, Vail, Colorado
| | | | | | - Thomas O Clanton
- Steadman Philippon Research Institute, Vail, Colorado.,The Steadman Clinic, Vail, Colorado
| |
Collapse
|
14
|
Liu S, Peng Y, Liu J, Ou Z, Wang Z, Rai S, Lin W, Tang X. Small incision reduction and external fixation for the treatment of delayed over fourteen days supracondylar humeral fractures in children. Front Pediatr 2022; 10:1039704. [PMID: 36405828 PMCID: PMC9668058 DOI: 10.3389/fped.2022.1039704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Supracondylar humeral fractures (SHF) are the most common type of fracture occurring at the distal humerus in children. In patients with delayed presentation of SHF, closed reduction is challenging to achieve with traditional reduction maneuvers. This study aimed to report the clinical results of pediatric SHF delayed over 14 days treated by closed reduction with a minimally invasive technique and external fixation and evaluate the efficacy of this technique. METHODS Between October 2010 and September 2018, children with delayed presentation of SHF over 14 days were retrospectively included in this study. The patients received closed reduction with a minimally invasive technique followed by external fixation. The demographics and radiographic data were collected. The Mayo Elbow Performance Score (MEPS) and the Flynn criteria were used to evaluate the clinical outcomes of treatments. RESULTS A total of 11 children (aged 4-13 years) with delayed presentation (range, 14-22 days) were recruited. They received surgery using closed reduction with a minimally invasive technique followed by external fixation. None of the surgery was done with the open method. After surgery, the patients' carrying angle returned to normal. The radiological union was evident in 8 to 12 weeks in all fractures without complications. Every patient had a good to excellent score on the MEPS and the Flynn criteria. CONCLUSIONS The results of this series indicated a satisfactory outcome in children with delayed more than 14 days of supracondylar humeral fractures. The closed reduction with a minimally invasive technique followed by external fixation is an alternative treatment for such injury.
Collapse
Affiliation(s)
- Shuai Liu
- Pediatric Orthopedics Department, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China
| | - YingYing Peng
- Department of Orthopaedic, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - JiaTong Liu
- Department of Orthopaedic, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - ZiXuan Ou
- Department of Orthopaedic, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - ZeZheng Wang
- Department of Orthopaedic, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Saroj Rai
- Department of Orthopaedics and Trauma Surgery, Karama Medical Center, Dubai, United Arab Emirates
| | - WeiFeng Lin
- Pediatric Orthopedics Department, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China
| | - Xin Tang
- Department of Orthopaedic, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
15
|
Pagano L, Durante C, Tufano RP. Editorial: Radiofrequency Ablation as an Alternative to Conventional Treatment. Front Endocrinol (Lausanne) 2022; 13:883809. [PMID: 35573996 PMCID: PMC9091301 DOI: 10.3389/fendo.2022.883809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/02/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Loredana Pagano
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Ralph Patrick Tufano
- Department Head and Neck Endocrine Surgery, Sarasota Memorial Health Care System, Sarasota, FL, United States
| |
Collapse
|
16
|
Bartella I, Fransen LFC, Gutschow CA, Bruns CJ, van Berge Henegouwen ML, Chaudry MA, Cheong E, Cuesta MA, Van Daele E, Gisbertz SS, van Hillegersberg R, Hölscher A, Mercer S, Moorthy K, Nafteux P, Nilsson M, Pattyn P, Piessen G, Räsanen J, Rosman C, Ruurda JP, Schneider PM, Sgromo B, Nieuwenhuijzen GA, Luyer MDP, Schröder W. Technique of open and minimally invasive intrathoracic reconstruction following esophagectomy-an expert consensus based on a modified Delphi process. Dis Esophagus 2021; 34:6102597. [PMID: 33846718 DOI: 10.1093/dote/doaa127] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/11/2020] [Accepted: 11/21/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND In recent years, minimally invasive Ivor Lewis (IL) esophagectomy with high intrathoracic anastomosis has emerged as surgical standard of care for esophageal cancer in expert centers. Alongside this process, many divergent technical aspects of this procedure have been devised in different centers. This study aims at achieving international consensus on the surgical steps of IL reconstruction using Delphi methodology. METHODS The expert panel consisted of specialized esophageal surgeons from 8 European countries. During a two-round Delphi process, a detailed analysis and consensus on key steps of intrathoracic gastric tube reconstruction (IL esophagectomy) was performed. RESULTS Response rates in Delphi rounds 1 and 2 were 100% (22 of 22 experts) and 83.3% (20 of 24 experts), respectively. Three essential technical areas of intrathoracic gastric tube reconstruction were identified: first, vascularization of the gastric conduit, second, gastric mobilization, tube formation and pull-up, and third, anastomotic technique. In addition, 3 main techniques for minimally invasive intrathoracic anastomosis are currently practiced: (i) end-to-side circular stapled, (ii) end-to-side double stapling, and (iii) side-to-side linear stapled technique. The step-by-step procedural analysis unveiled common approaches but also different expert practice. CONCLUSION This precise technical description may serve as a clinical guideline for intrathoracic reconstruction after esophagectomy. In addition, the results may aid to harmonize the technical evolution of this complex surgical procedure and thereby facilitate surgical training.
Collapse
Affiliation(s)
- Isabel Bartella
- Department of General, Visceral and Cancer Surgery, University Hospital Cologne, Cologne, Germany
| | - Laura F C Fransen
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Christian A Gutschow
- Department of General and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Christiane J Bruns
- Department of General, Visceral and Cancer Surgery, University Hospital Cologne, Cologne, Germany
| | - Mark L van Berge Henegouwen
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - M Asif Chaudry
- Department of Surgery, The Royal Marsden Hospital, London, UK
| | - Edward Cheong
- Department of Upper GI Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| | - Miguel A Cuesta
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Elke Van Daele
- Department of GI Surgery, University Hospital Ghent, Ghent, Belgium
| | - Suzanne S Gisbertz
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | | | - Arnulf Hölscher
- Center for Esophageal and Gastric Cancer Surgery, Markushospital Frankfurt, Frankfurt am Main, Germany
| | - Stuart Mercer
- Department of Upper GI Surgery, Queen Alexandra Hospital, Portsmouth, UK
| | - Krishna Moorthy
- Department of Surgery and Cancer, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Philippe Nafteux
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Magnus Nilsson
- Department of Upper Abdominal Disease, Karolinska University Hospital, Stockholm, Sweden
| | - Piet Pattyn
- Department of GI Surgery, University Hospital Ghent, Ghent, Belgium
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, Lille University Hospital, Lille, France
| | - Jari Räsanen
- Department of General Thoracic and Esophageal Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Camiel Rosman
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jelle P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Paul M Schneider
- Department of General and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Bruno Sgromo
- Department of Upper GI Surgery, Oxford University Hospitals, Oxford, UK
| | | | - Misha D P Luyer
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Wolfgang Schröder
- Department of General, Visceral and Cancer Surgery, University Hospital Cologne, Cologne, Germany
| |
Collapse
|
17
|
Borges LPB, DA Costa FLS, Rossy KC, Dos Santos GMA, Silva CRG, Albuquerque RS, Guilherme BC, Cunha MS, Oliveira RA, Araújo LHV, Gurgel HJ, Barroso JPM, Monteiro FDO, Viana RB, Teixeira PPM. Topographic laparoscopy for buffaloes in the quadruped position. J Vet Med Sci 2021; 83:1315-1320. [PMID: 34162781 PMCID: PMC8437727 DOI: 10.1292/jvms.20-0582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study aimed to describe the anatomical topography of the abdominal cavity of buffaloes in the quadruped position to establish the best endosurgical access and vantage points and identify possible limitations. Laparoscopies were performed on 10 healthy female buffaloes obtained from the Universidade Federal Rural da Amazônia to explore possible access points to the abdomen. Techniques for assessing and possibly observing certain organs and structures through the left and right flanks of 10 animals have been described. In five animals, access was created through the right side of the last intercostal space to allow more cranial access to the abdominal cavity. Despite the presence of the rumen, access through the left flank allowed the visualization of the structures of the gastrointestinal tract and the genitourinary system. With access through the right flank, however, imaging was hampered by the presence of the greater omentum and its deep and superficial walls, which prevented the progression of the endoscope. Access through the last right intercostal space allowed the visualization of the cranial structures of the abdominal cavity, such as the caudate process, right lobe of the liver, right kidney, and pancreas. Laparoscopic access through the left flank and the last intercostal space in healthy buffaloes in the quadruped position is feasible, and it is promising for the exploration, diagnosis, and treatment of various disorders in buffaloes.
Collapse
Affiliation(s)
- Luisa P B Borges
- Institute of Veterinary Medicine, Veterinary Hospital, Universit Federal do Pará (UFPA), Castanhal-Pará 68740-970, Brazil
| | - Filipe L S DA Costa
- Institute of Veterinary Medicine, Veterinary Hospital, Universit Federal do Pará (UFPA), Castanhal-Pará 68740-970, Brazil
| | - Kayan C Rossy
- Institute of Veterinary Medicine, Veterinary Hospital, Universit Federal do Pará (UFPA), Castanhal-Pará 68740-970, Brazil
| | - Gabriela M A Dos Santos
- Institute of Veterinary Medicine, Veterinary Hospital, Universit Federal do Pará (UFPA), Castanhal-Pará 68740-970, Brazil
| | - Carla R G Silva
- Institute of Veterinary Medicine, Veterinary Hospital, Universit Federal do Pará (UFPA), Castanhal-Pará 68740-970, Brazil
| | - Rodrigo S Albuquerque
- Institute of Veterinary Medicine, Veterinary Hospital, Universit Federal do Pará (UFPA), Castanhal-Pará 68740-970, Brazil
| | - Bárbara C Guilherme
- Institute of Veterinary Medicine, Veterinary Hospital, Universit Federal do Pará (UFPA), Castanhal-Pará 68740-970, Brazil
| | - Michel S Cunha
- Institute of Veterinary Medicine, Veterinary Hospital, Universit Federal do Pará (UFPA), Castanhal-Pará 68740-970, Brazil
| | - Renato A Oliveira
- Institute of Veterinary Medicine, Veterinary Hospital, Universit Federal do Pará (UFPA), Castanhal-Pará 68740-970, Brazil
| | - Luiz H V Araújo
- Institute of Veterinary Medicine, Veterinary Hospital, Universit Federal do Pará (UFPA), Castanhal-Pará 68740-970, Brazil
| | - Heytor J Gurgel
- Institute of Veterinary Medicine, Veterinary Hospital, Universit Federal do Pará (UFPA), Castanhal-Pará 68740-970, Brazil
| | - João P M Barroso
- Institute of Veterinary Medicine, Veterinary Hospital, Universit Federal do Pará (UFPA), Castanhal-Pará 68740-970, Brazil
| | - Francisco D O Monteiro
- Institute of Veterinary Medicine, Veterinary Hospital, Universit Federal do Pará (UFPA), Castanhal-Pará 68740-970, Brazil
| | - Rinaldo B Viana
- Institute of Animal Health and Production, Federal Rural University of Amazonia (ISPA/UFRA), Belém-Pará 66095-780, Brazil
| | - Pedro P M Teixeira
- Institute of Veterinary Medicine, Veterinary Hospital, Universit Federal do Pará (UFPA), Castanhal-Pará 68740-970, Brazil
| |
Collapse
|
18
|
Zeng B, Wu C, Li T, Wang X, Shang Q. [Three-dimensional printed drill guide template assisting percutaneous pedicle screw fixation for multiple-level thoracolumbar fractures]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2021; 35:742-749. [PMID: 34142502 DOI: 10.7507/1002-1892.202012081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To evaluate the feasibility and safety of three-dimensional (3D) printed drill guide template-assisted percutaneous pedicle screw fixation for multiple-level thoracolumbar fractures. Methods Clinical data of 19 patients with multilevel thoracolumbar fracture without nerve injury who underwent surgical treatment between May 2017 and January 2019 were retrospectively analyzed. There were 9 males and 10 females and their age ranged from 22 to 63 years, with an average age of 43.6 years. Injury cause included traffic accident injury in 12 cases, and fall from height injury in 7 cases. A total of 40 fractured vertebrae were involved in T 10 to L 3 levels. According to AO classification, there were 29 fractures of type A1, 9 fractures of type A2, and 2 fractures of type A3. According to TANG Sanyuan classification, multiple-segment thoracolumbar fractures were classified as 17 cases of type ⅠA, 1 case of type ⅠB, and 1 case of type ⅡC. The time from injury to operation was 2-6 days, with an average of 3.1 days. The 3D-printed universal drill guide template was used for assisting percutaneous pedicle screw fixation during operation. Intraoperative blood loss, average operation time and fluoroscopy frequency of each screw were recorded. Visual analogue scale (VAS) score was used to evaluate the improvement of low back pain before operation, at 3 days after operation, and at last follow-up. According to the CT at 3 days after operation, the Gertzbein and Robbins scales were used to evaluate the accuracy of screw insertion (the grade A and grade B were regarded as accuracy, the grade A was regarded as excellent of screw insertion). The Cobb angle in sagittal plane of the fracture segment was measured, and the percentage of anterior edge of injured vertebral height was calculated. The consistency of the inclination of bilateral pedicle screws were analyzed postoperatively, and compared the angle of the intraoperative guide plate with the inclination of screw to verify the effectiveness of the guide plate in controlling the inclination. Results All the 19 patients completed the operation successfully, and the intraoperative blood loss was 44-67 mL, with an average of 54.3 mL. The average operation time for each screw insertion was 7.3-11.1 minutes, with an average of 9.6 minutes. The average fluoroscopy frequency of each screw insertion was 1.6-2.5 times, with an average of 2.0 times. No spinal cord, nerve root injury, infection, and other complications occurred. All patients were followed up 24-38 months, with an average of 28.7 months. The accuracy of pedicle screws was evaluated by using Gertzbein and Robbins scales: 145 screws were grade A and 11 screws were grade B. The accuracy of screw insertion was 100% and the excellent rate was 92.9%. The CT data at 3 days after operation showed no significant difference in the inclination between the left and right screws in the same vertebral body ( t=0.93, P=0.36). There was no significant difference between the angle of guide plate and the screw inclination ( P>0.05). The VAS score, Cobb angle in sagittal plane, and the percentage of anterior edge of injured vertebral height were significantly improved at 3 days after operation and at last follow-up, and the VAS score was declined at last follow-up compared with 3 days after operation, all showing significant differences ( P<0.05). There was no significant difference in the sagittal Cobb angle and the percentage of anterior edge of injured vertebral height between two postoperative time points ( P>0.05). At last follow-up, no internal fixators were loosened or broken, and all fractures healed well. Conclusion For the multiple-level thoracolumbar fractures, 3D-printed drill guide template assisting percutaneous pedicle screw fixation can reduce the operation time, intraoperative blood loss, and fluoroscopy frequency and the screw insertion is accurate and has a good reduction effect.
Collapse
Affiliation(s)
- Baifang Zeng
- Department of Spine Surgery, Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China.,Department of Spine and Traumatology Surgery, Zigong Fourth People's Hospital, Zigong Sichuan, 643000, P.R.China
| | - Chao Wu
- Department of Spine Surgery, Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China.,Department of Spine and Traumatology Surgery, Zigong Fourth People's Hospital, Zigong Sichuan, 643000, P.R.China
| | - Tao Li
- Department of Spine and Traumatology Surgery, Zigong Fourth People's Hospital, Zigong Sichuan, 643000, P.R.China
| | - Xiangyu Wang
- Department of Spine and Traumatology Surgery, Zigong Fourth People's Hospital, Zigong Sichuan, 643000, P.R.China
| | - Qing Shang
- Department of Spine Surgery, Fushun People's Hospital, Fushun Sichuan, 643200, P.R.China
| |
Collapse
|
19
|
Zhao Y, Jiang Z, Li T, Xu C, Han L, Chu F, Wu B, Gao M, Wang H. [Treatment of irreducible intertrochanteric femoral fracture with minimally invasive clamp reduction technique via anterior approach]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2021; 35:544-549. [PMID: 33998205 DOI: 10.7507/1002-1892.202012030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To explore the effectiveness of minimally invasive clamp reduction technique via anterior approach in treatment of irreducible intertrochanteric femoral fractures. Methods Between January 2015 and January 2019, 59 patients with irreducible intertrochanteric femoral fractures were treated with minimally invasive clamp reduction technique via anterior approach. There were 29 males and 30 females with an average age of 77.9 years (range, 45-100 years). The causes of injury included falling in 46 cases, traffic accident in 6 cases, smashing in 2 cases, and falling from height in 5 cases. The time from injury to operation was 1-14 days (mean, 3.8 days). The fractures were classified as AO type 31-A1 in 12 cases, type 31-A2 in 25 cases, type 31-A3 in 22 cases. Results All fractures were reduced well and the fracture reduction took 10 to 30 minutes, with an average of 19 minutes. All patients were followed up 13-25 months, with an average of 17.6 months. Among them, 2 cases of pronation displacement of proximal fracture segment died for infection or falling pneumonia after internal fixation failed. Six patients with reversed intertrochanteric femoral fractures experienced re-pronation and abduction displacement of the lateral wall after internal fixation, but the fractures all healed. The rest of the patients had no fracture reduction loss, and the fractures healed with an average healing time of 5.9 months (range, 3-9 months). Except for 2 patients who died, the Harris score of hip joint function of the remaining 57 patients was excellent in 49 cases and good in 8 cases at last follow-up. Conclusion The minimally invasive clamp reduction technique via anterior approach for irreducible intertrochanteric femoral fractures is simple and effective. For irreducible intertrochanteric femoral fractures related to lateral wall displacement, after clamp reduction and intramedullary nail fixation, the lateral wall should be reinforced in order to avoid reduction loss and internal fixation failure.
Collapse
Affiliation(s)
- Yifeng Zhao
- Department of Traumatic Orthopedics, Affiliated Hospital of Jining Medical University, Jining Shandong, 272029, P.R.China
| | - Zhen Jiang
- Department of Traumatic Orthopedics, Affiliated Hospital of Jining Medical University, Jining Shandong, 272029, P.R.China
| | - Tao Li
- Department of Orthopedics, Wenshang People's Hospital, Jining Shandong, 272501, P.R.China
| | - Chongyang Xu
- Department of Imaging, Huaiyin People's Hospital, Jinan Shandong, 250000, P.R.China
| | - Liang Han
- Department of Traumatic Orthopedics, Affiliated Hospital of Jining Medical University, Jining Shandong, 272029, P.R.China
| | - Fenglong Chu
- Department of Traumatic Orthopedics, Affiliated Hospital of Jining Medical University, Jining Shandong, 272029, P.R.China
| | - Bin Wu
- Department of Traumatic Orthopedics, Affiliated Hospital of Jining Medical University, Jining Shandong, 272029, P.R.China
| | - Ming Gao
- Department of Traumatic Orthopedics, Affiliated Hospital of Jining Medical University, Jining Shandong, 272029, P.R.China
| | - Haibin Wang
- Department of Traumatic Orthopedics, Affiliated Hospital of Jining Medical University, Jining Shandong, 272029, P.R.China
| |
Collapse
|
20
|
Pogoda KA, Malinowski A, Majchrzak-Baczmanska D, Wosiak A. The analysis of vaginal hysterectomy results depending on the uterine size. Ginekol Pol 2021; 92:339-43. [PMID: 33844245 DOI: 10.5603/GP.a2021.0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/05/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Vaginal hysterectomy is one of the oldest but still rarely used minimally invasive techniques. Although new surgical methods making use of robots in laparoscopy have been introduced recently, when compared with vaginal hysterectomy, these approaches do not offer significant benefits for the patients and the doctors operating on them. The purpose of this study was a thorough analysis of vaginal removal of non-prolapsed uterus with benign pathology. MATERIAL AND METHODS The analysis included data of 1148 women who underwent vaginal hysterectomy in the Clinic of Surgical, Endoscopic and Oncological Gynecology between 2002 and 2014. A group of patients operated on were assessed, and data from the surgeries were obtained paying attention to such aspects as the operating time, the evaluation of morphotic blood elements, the type of perioperative complications, and the length of postoperative hospital stay. Additionally, all vaginal hysterectomies were divided into groups and analyzed taking into consideration uterus weight. RESULTS Vaginal hysterectomy was performed even in cases of earlier abdominal surgeries. The mean operating time was and 69.51 ± 28.32 minutes. The patients left hospital after 2.93 days on average. The mean uterus weight was 179.69 ± 113.54 g. What is important, the enlarged uterus was not a significant obstacle during the surgery. In case of heavy uteri of more than 580g, when the fundus of the uterus reached above the navel, the attention was drawn to the need for careful preparatory procedures, which reduced the number of perioperative complications and thus had a significant influence on the length of the operation (p = 0.0170). CONCLUSIONS Vaginal hysterectomy is an operating technique which is relatively easy to perform and safe for the patients because it involves a slight decrease of morphotic blood elements and a small number of mid- and postoperative complications. Vaginal hysterectomy is not a contraindication in case of large uteri, even those of more than 1000 g; however, in such cases, a longer operating time and an increased number of perioperative complications must be taken into consideration.
Collapse
|
21
|
Nebbia M, Kotze PG, Spinelli A. Training on Minimally Invasive Colorectal Surgery during Surgical Residency: Integrating Surgical Education and Advanced Techniques. Clin Colon Rectal Surg 2021; 34:194-200. [PMID: 33815002 DOI: 10.1055/s-0041-1722843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Surgery is an ever-evolving discipline and continually incorporates new technologies that have improved the ability of the operating room surgeon to perform. The next generation of minimally invasive surgery includes laparoscopic and robotic-assisted procedures. Graduating residents may be expected to have the skills to perform common colorectal procedures using these technologies, and residency programs are developing curriculums to teach these skills. Minimally invasive techniques are challenging and learning only by observation and practice alone is difficult. This requires dedicated training and mentoring. New simulation methods have been conceived specifically for minimally invasive procedures, and these embrace a combination of virtual reality simulators and box trainers, with animal and human tissue, as well as synthetic materials. The aim of this review is to provide an overview of training in minimally invasive colorectal surgery with a focus on different types of simulators that build the basis to develop and include a multistep training approach in a structured training curriculum for minimally invasive colorectal procedures.
Collapse
Affiliation(s)
- Martina Nebbia
- Department of Surgery, Colon and Rectal Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Paulo Gustavo Kotze
- Colorectal Surgery Unit, IBD Outpatient Clinics, Health Sciences Postgraduate Program, Catholic University of Paraná (PUCPR), Curitiba, Brazil
| | - Antonino Spinelli
- Division of Colon and Rectal Surgery, Humanitas Clinical and Research Center, IRCCS Humanitas University, Department of Biomedical Sciences, Rozzano, Milan, Italy
| |
Collapse
|
22
|
Park CH, Na HD, Chang MC. Clinical Outcomes of Minimally Invasive Repair Using Ring Forceps for Acute Achilles Tendon Rupture. J Foot Ankle Surg 2021; 60:237-241. [PMID: 33358383 DOI: 10.1053/j.jfas.2020.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 03/07/2020] [Indexed: 02/08/2023]
Abstract
Mini-open techniques using special devices, introduced to preclude the complications of open and percutaneous techniques, have limited usefulness because of the need for the devices and the weak strength of the repair. We developed a mini-open technique using a ring forceps. This technique is easy to use and increases the strength of the repair with crossed sutures. Twenty-six consecutive patients were treated using a mini-open technique using a ring forceps for acute Achilles tendon rupture. American Orthopaedic Foot and Ankle Society (AOFAS) scores and Achilles tendon total rupture scores (ATRS) were evaluated at the last follow-up. The active range of motion of ankle joint and maximum calf circumference (MCC) were measured and compared with the uninjured side at the last follow-up, as well as hopping and single-limb heel-rise (SLHR) tests and isokinetic tests for ankle plantarflexion. AOFAS score and ATRS were 92.2 ± 9.4 and 89.9 ± 10.9, respectively, at the last follow-up. The MCC (p = .035) and maximum height of SLHR (p = .001) were significantly different between uninvolved and involved legs. No significant differences in mean peak torques for plantarflexion at angular speeds of 30°/s (60.9 ± 23.6 vs 50.8 ± 20.4 Nm/kg; p = .299) and 120°/s (31.6 ± 16 vs 29.6 ± 17.7 Nm/kg; p = .776) were observed between uninvolved and involved legs. The mini-open technique using a ring forceps for acute Achilles tendon rupture showed satisfactory clinical outcomes and favorable functional outcomes without complications.
Collapse
Affiliation(s)
- Chul Hyun Park
- Professor, Department of Orthopaedic Surgery, Yeungnam University Medical Center, Daegu, Korea.
| | - Ho Dong Na
- Surgeon, Department of Orthopaedic Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Min Cheol Chang
- Professor, Department of Physical Medicine and Rehabilitation, Yeungnam University Medical Center, Daegu, Korea
| |
Collapse
|
23
|
Xia D, Zhang Y, Ou T, Wang Y, Hao Z, Zhou P, Xu S. Combination of mini locking plate and nitinol arched shape-memory connector for purely lateral malleolus fractures: technique and clinical results. Ann Transl Med 2021; 8:1573. [PMID: 33437772 PMCID: PMC7791235 DOI: 10.21037/atm-20-4055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Lateral malleolus fractures occur frequently. The common techniques for fixing purely lateral malleolus fractures are often challenging, owing to the extent of soft tissue damage and fracture non-union. Herein, we report a new treatment that entails minimally invasive insertion and continuous compression of the broken ends as a novel technique, and evaluate its clinical results. Methods This study enrolled 21 patients (13 males and 8 females; mean age 32.06±3.45 years, range 23–69 years) with purely lateral malleolus fractures. Each patient underwent open reduction treatment with a mini locking plate for internal fixation and compression of the fracture end with an Arched Shape-Memory Connector (ASC). The clinical assessments were made using the American Orthopedic Foot and Ankle Society (AOFAS) scores, which were recorded at the final follow-up visit. Results The patients were followed for an average of 14.7±1.2 months (range, 12–18 months). None of the patients showed surgical failure, and all of the purely lateral malleolus fractures healed in an average of 12.6±1.5 weeks (range, 10–16 weeks). The mean AOFAS score was 88.94 (range, 83–90). Conclusions The new treatment had beneficial outcomes for purely lateral malleolus fractures. Mini locking plates are minimally invasive for surgical intervention, and combined with continuous concentrated compression with an ASC to accelerate osseous healing, they aid in restoration of function and enable early rehabilitation with a low incidence of postoperative complications.
Collapse
Affiliation(s)
- Demeng Xia
- Department of Emergency, Changhai Hospital, Naval Medical University, Shanghai, China.,Department of Orthopaedics, The Naval Hospital of Eastern Theater Command of PLA, Zhoushan, China
| | - Yuntong Zhang
- Department of Emergency, Changhai Hospital, Naval Medical University, Shanghai, China.,Department of Orthopedics, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Tianle Ou
- Department of Clinical Medicine, The Naval Medical University, Shanghai, China
| | - Yang Wang
- Department of Emergency, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Zichen Hao
- Department of Emergency, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Panyu Zhou
- Department of Emergency, Changhai Hospital, Naval Medical University, Shanghai, China.,Department of Orthopedics, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Shuogui Xu
- Department of Emergency, Changhai Hospital, Naval Medical University, Shanghai, China.,Department of Orthopedics, Changhai Hospital, Naval Medical University, Shanghai, China
| |
Collapse
|
24
|
Pitale U, Pal PC, Thakare G, Verma M, Dhakad S, Pandey R. Minimally invasive therapy for reconstruction of lost interdental papilla by using injectable hyaluronic acid filler. J Indian Soc Periodontol 2021; 25:22-28. [PMID: 33642737 PMCID: PMC7904010 DOI: 10.4103/jisp.jisp_19_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 06/14/2020] [Accepted: 07/08/2020] [Indexed: 11/26/2022] Open
Abstract
Background and Aim: Reconstruction of interdental papillae (IDP) is among the most difficult periodontal therapy. Papillary recession is multifactorial, and several surgical, nonsurgical, and minimally invasive techniques have been suggested. The purpose of this study was to evaluate the clinical application of injectable hyaluronic acid (HA) gel for the reconstruction of IDP in Nordland and Tarnow's Class I and II papillary recession cases. Materials and Methods: In the present in vivo clinical trial, 7 patients (2 males, 5 females) with 25 defects were selected. A volume of 0.2 ml HA gel was injected at the respective areas and massaged for 2–3 min. Photographs were obtained, and the assessment of the data was performed clinically (CP-GM, interproximal width [IPW]) and by Image analysis software (black triangle height [BTH], black triangle width [BTW]). Comparison of mean values was performed using the analysis of variance, followed by Post hoc Bonferroni test. Value of P ≤ 0.05 was considered statistically significant. Results: Application of HA gel for the reconstruction of IDP was successful in 6 months. CP-GM, BTH, IPW, and BTW showed a statistically significant difference from baseline to 3 and 6 months interval (P = 0.01). Post hoc Bonferroni test for CP-GM, BTH, BTW, and IPW revealed a statistically significant difference from baseline to 3 months (P ≤ 0.05) and 6 months (P ≤ 0.05) and a nonsignificant difference at 3–6 months (P ≥ 0.05). Conclusion: Injectable HA gel is a promising minimally invasive therapy for enhancing papillary esthetics.
Collapse
Affiliation(s)
- Unnati Pitale
- Department of Periodontics, Modern Dental College and Research Centre, Indore, Madhya Pradesh, India
| | - Pritish Chandra Pal
- Department of Periodontics, Modern Dental College and Research Centre, Indore, Madhya Pradesh, India
| | - Gauri Thakare
- Department of Microbiology, Indira Gandhi Government Medical College and Mayo Hospital, Nagpur, Maharashtra, India
| | - Manish Verma
- Department of Periodontics, Government College of Dentistry, Indore, Madhya Pradesh, India
| | - Shikha Dhakad
- Department of Periodontics, Chhattisgarh Dental College and Research Institute, Chhattisgarh, India
| | - Rohit Pandey
- Department of Periodontics, Modern Dental College and Research Centre, Indore, Madhya Pradesh, India
| |
Collapse
|
25
|
Dotlacil V, Rygl M, Frybova B. Initial experience with minimally invasive treatment of pilonidal sinus in children. Wideochir Inne Tech Maloinwazyjne 2021; 16:417-22. [PMID: 34136040 DOI: 10.5114/wiitm.2020.100714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/12/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Sinus pilonidalis (SP) is an acquired inflammatory disease, which is relatively common in the paediatric population. Surgery is indicated in symptomatic patients. In 2017, minimally invasive pilonidal sinus treatment (EPSiT) was adapted to the paediatric population. Aim To evaluate the first experience with minimally invasive endoscopic treatment of SP (PEPSiT) in children and adolescents in the Czech Republic. Material and methods A retrospective review of all consecutive paediatric patients who underwent PEPSiT from November 2018 to February 2020. The monitored parameters were demographics, perioperative course of the disease, surgery, length of hospitalisation, postoperative complications, healing, disease recurrence, and follow-up. Results Seventeen patients were enrolled in the study. The median age at surgery was 17.1 years (range: 12.5-18). The subjects comprised 76% males, and the median body mass index was 25.6 kg/m2 (range: 17-30.3 kg/m2). Thirteen patients underwent previous surgical treatment (76%) under local anaesthesia. The median duration of PEPSiT was 50 min (range: 30-85 min). The subjective evaluation of pain by patients on the VAS scale was 0 on the day of discharge. There were no postoperative complications up to the 30th postoperative day. Two disease recurrences were successfully managed by re-PEPSiT. By the end of follow-up, 14/15 patients had healed. Two patients are still within 3 months of surgery, which is too soon to definitively evaluate possible recurrence of the disease. Conclusions These preliminary results show that PEPSiT is a highly promising method. It is safe and well-tolerated by patients (short hospital stay, quick return to normal life, low pain and analgesic consumption). Two recurrences of disease were treated by re-PEPSiT.
Collapse
|
26
|
Czigléczki G, Nagy Z, Padányi C, Banczerowski P. Biportal endoscopic technique in the treatment of spinal stenosis: early clinical experiences and results. Neurol Res 2020; 42:1085-1088. [PMID: 32892719 DOI: 10.1080/01616412.2020.1803603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Minimally invasive procedures in spine surgery have undergone significant development in recent times. A demand emerged from both surgeons and patients to develop and perform these types of surgeries in order to prevent biomechanical and surgical complications. Our study aimed to present early clinical results of a biportal endoscopy technique in the treatment of degenerative spinal stenosis. METHOD We created a retrospective database of patients who underwent biportal spinal endoscopic decompression at the National Institute of Clinical Neuroscience, Department of Neurosurgery, Semmelweis University, Budapest, Hungary, in 2019. The surgical steps of technique is discussed in details. RESULTS Retrospectively, we identified and collected 21 patients in our retrospective analysis. The early results after endoscopic decompression were excellent, 17 patients (81%) mentioned good general comfort which coincided with small incisions and the preservation of posterior spinal muscles. Three patients (14%) mentioned good condition and minor postoperative pain which could be controlled with analgesics. One patients (5%) mentioned postoperative discomfort. The patients were controlled at 3, 6 and 9 months. The mean follow-up time was 7 months. DISCUSSION Biportal endoscopic technique was developed to fulfil the requirements of minimally invasive techniques. Our results indicate this method may be highly effective for the treatment of lumbar spinal stenosis and an alternative to conventional microsurgical decompression; however, our study limited by its retrospective manner and small population size.
Collapse
Affiliation(s)
- Gábor Czigléczki
- Department of Spinal Surgery, National Institute of Clinical Neurosciences , Budapest, Hungary.,Department of Neurosurgery, Semmelweis University , Budapest, Hungary
| | - Zoltan Nagy
- Department of Spinal Surgery, National Institute of Clinical Neurosciences , Budapest, Hungary.,Department of Neurosurgery, Semmelweis University , Budapest, Hungary
| | - Csaba Padányi
- Department of Spinal Surgery, National Institute of Clinical Neurosciences , Budapest, Hungary
| | - Péter Banczerowski
- Department of Spinal Surgery, National Institute of Clinical Neurosciences , Budapest, Hungary.,Department of Neurosurgery, Semmelweis University , Budapest, Hungary
| |
Collapse
|
27
|
张 宇, 李 富, 西 信, 曾 至, 麻 彬, 谢 宁, 于 研, 程 黎. [Comparison of intervertebral height and lordosis of fusion segment between open- and minimally invasive-transforaminal lumbar interbody fusions]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2020; 34:422-427. [PMID: 32291975 PMCID: PMC8171520 DOI: 10.7507/1002-1892.201910060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 02/14/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To analyze the restoration of intervertebral height and lordosis of fusion segment after open-transforaminal lumbar interbody fusion (Open-TLIF) and minimally invasive-TLIF (MIS-TLIF). METHODS Between January 2013 and February 2016, patients who treated with TLIF due to lumbar degenerative diseases and met the selection criteria were selected as the study objects. Among them, 41 patients were treated with open-TLIF (Open-TLIF group), 34 patients were treated with MIS-TLIF (MIS-TLIF group). There was no significant difference between the two groups ( P>0.05) in gender, age, body mass index, disease type, disease duration, pathological segment, and other general data. The intraoperative bleeding volume, hospital stay, visual analogue scale (VAS) score of waist and leg, and Oswestry disability index (ODI) were recorded before and after operation. The anterior disc height (ADH), posterior disc height (ADH), and segmental lordosis (SL) of fusion segment were measured by X-ray film before and at 6 months after operation. The differences of ADH, PDH, and SL between pre- and post-operation were calculated. RESULTS The intraoperative bleeding volume and hospital stay in Open-TLIF group were significantly higher than those in MIS-TLIF group ( t=14.619, P=0.000; t=10.021, P=0.000). All incisions healed by first intention without early complications. All patients were followed up 6-24 months (mean, 12.6 months) in Open-TLIF group and 6-24 months (mean, 11.5 months) in MIS-TLIF group. The preoperative VAS scores of waist and leg and ODI of the two groups significantly improved ( P<0.05). There was no significant difference in VAS scores and ODI between the two groups before operation and at 2 weeks and 6 months after operation ( P>0.05). Imaging examination showed the good intervertebral fusion. There was no significant difference in ADH, PDH, and SL between the two groups before operation and at 6 months after operation ( P>0.05). The differences of ADH, PDH, and SL between the two groups were not significant ( P>0.05). The ADH, PDH, and SL after operation significantly increased in the two groups ( P<0.05). CONCLUSION Open-TLIF and MIS-TLIF show similar effectiveness and radiological change in the treatment of single lumbar degenerative diseases and the improved intervertebral height and lordosis, but MIS-TLIF can significantly reduce hospital stay and intraoperative blood loss.
Collapse
Affiliation(s)
- 宇雷 张
- 同济大学附属同济医院影像科(上海 200065)Department of Radiology, Tongji Hospital, Tongji University, Shanghai, 200065, P.R.China
| | - 富平 李
- 同济大学附属同济医院影像科(上海 200065)Department of Radiology, Tongji Hospital, Tongji University, Shanghai, 200065, P.R.China
| | - 信 西
- 同济大学附属同济医院影像科(上海 200065)Department of Radiology, Tongji Hospital, Tongji University, Shanghai, 200065, P.R.China
| | - 至立 曾
- 同济大学附属同济医院影像科(上海 200065)Department of Radiology, Tongji Hospital, Tongji University, Shanghai, 200065, P.R.China
| | - 彬 麻
- 同济大学附属同济医院影像科(上海 200065)Department of Radiology, Tongji Hospital, Tongji University, Shanghai, 200065, P.R.China
| | - 宁 谢
- 同济大学附属同济医院影像科(上海 200065)Department of Radiology, Tongji Hospital, Tongji University, Shanghai, 200065, P.R.China
| | - 研 于
- 同济大学附属同济医院影像科(上海 200065)Department of Radiology, Tongji Hospital, Tongji University, Shanghai, 200065, P.R.China
| | - 黎明 程
- 同济大学附属同济医院影像科(上海 200065)Department of Radiology, Tongji Hospital, Tongji University, Shanghai, 200065, P.R.China
| |
Collapse
|
28
|
Abstract
BACKGROUND Plate fixation using traditional lateral L-shape approach for intra-articular calcaneal fractures is complicated by 30% of wound complications, and the lateral small incision techniques with a tarsal sinus approach cannot sufficiently address all the fragments. A modified tarsal sinus approach with combined advantages of traditional lateral L-shape and tarsal sinus approaches for the treatment of intra-articular calcaneal fractures was developed. METHOD This prospective study included 29 patients (13 Sanders type II and 16 type III) with calcaneal fractures were managed with this technique. Calcaneal height, width, length, Bohler's angle, and Gissane angle were measured preoperatively, postoperatively, and at 1-year follow-up. Functional outcomes were assessed based on American Orthopedic Foot and Ankle Society (AOFAS) ankle/hindfoot score. RESULTS Twenty-nine patients with average follow-up time of 18 (range 13-29) months were included. The radiographs demonstrated significant corrections of the Bohler's angle and Gissane angle, calcaneal width, length, and height from preoperation to postoperation and 1-year follow-up. Among all follow-up patients, one case had skin necrosis but healed after dressing. Another case had symptoms of numbness in the sural innervation area, which disappeared after 5 months of physical therapy and drug therapy. One case showed degenerative changes of subtalar joint at 1-year follow-up. No other wound complications like incision infection (superficial or deep) and wound dehiscence occurred. At 1-year follow-up, the mean AOFAS score was 90.2 ± 17.7 (range 70-98) and the good and excellent rate was 89.7%. CONCLUSION The modified tarsal sinus approach in the treatment of Sander's type II and III calcaneal fractures allowed adequate reduction and rigid fixation with low incidence of wound complications. Compared to sinus tarsi approach, this technique required shorter learning curve and was more easily mastered by young orthopedic surgeons. Thus, it was worthy of application clinically.
Collapse
Affiliation(s)
- Junfeng Zhan
- 1 Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China.,2 Department of Orthopaedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Chuanzhen Hu
- 3 Department of Orthopaedics Surgery, Shanghai Tenth People's Hospital Affiliated to Tongji University, Shanghai, China
| | - Nan Zhu
- 2 Department of Orthopaedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Wang Fang
- 2 Department of Orthopaedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Juehua Jing
- 2 Department of Orthopaedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Gang Wang
- 1 Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| |
Collapse
|
29
|
Arocho-Quinones EV, Lew SM, Handler MH, Tovar-Spinoza Z, Smyth M, Bollo R, Donahue D, Perry MS, Levy ML, Gonda D, Mangano FT, Storm PB, Price AV, Couture DE, Oluigbo C, Duhaime AC, Barnett GH, Muh CR, Sather MD, Fallah A, Wang AC, Bhatia S, Patel K, Tarima S, Graber S, Huckins S, Hafez DM, Rumalla K, Bailey L, Shandley S, Roach A, Alexander E, Jenkins W, Tsering D, Price G, Meola A, Evanoff W, Thompson EM, Brandmeir N. Magnetic resonance-guided stereotactic laser ablation therapy for the treatment of pediatric brain tumors: a multiinstitutional retrospective study. J Neurosurg Pediatr 2020; 26:13-21. [PMID: 32217793 PMCID: PMC7885863 DOI: 10.3171/2020.1.peds19496] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 01/22/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aimed to assess the safety and efficacy of MR-guided stereotactic laser ablation (SLA) therapy in the treatment of pediatric brain tumors. METHODS Data from 17 North American centers were retrospectively reviewed. Clinical, technical, and radiographic data for pediatric patients treated with SLA for a diagnosis of brain tumor from 2008 to 2016 were collected and analyzed. RESULTS A total of 86 patients (mean age 12.2 ± 4.5 years) with 76 low-grade (I or II) and 10 high-grade (III or IV) tumors were included. Tumor location included lobar (38.4%), deep (45.3%), and cerebellar (16.3%) compartments. The mean follow-up time was 24 months (median 18 months, range 3-72 months). At the last follow-up, the volume of SLA-treated tumors had decreased in 80.6% of patients with follow-up data. Patients with high-grade tumors were more likely to have an unchanged or larger tumor size after SLA treatment than those with low-grade tumors (OR 7.49, p = 0.0364). Subsequent surgery and adjuvant treatment were not required after SLA treatment in 90.4% and 86.7% of patients, respectively. Patients with high-grade tumors were more likely to receive subsequent surgery (OR 2.25, p = 0.4957) and adjuvant treatment (OR 3.77, p = 0.1711) after SLA therapy, without reaching significance. A total of 29 acute complications in 23 patients were reported and included malpositioned catheters (n = 3), intracranial hemorrhages (n = 2), transient neurological deficits (n = 11), permanent neurological deficits (n = 5), symptomatic perilesional edema (n = 2), hydrocephalus (n = 4), and death (n = 2). On long-term follow-up, 3 patients were reported to have worsened neuropsychological test results. Pre-SLA tumor volume, tumor location, number of laser trajectories, and number of lesions created did not result in a significantly increased risk of complications; however, the odds of complications increased by 14% (OR 1.14, p = 0.0159) with every 1-cm3 increase in the volume of the lesion created. CONCLUSIONS SLA is an effective, minimally invasive treatment option for pediatric brain tumors, although it is not without risks. Limiting the volume of the generated thermal lesion may help decrease the incidence of complications.
Collapse
Affiliation(s)
| | - Sean M. Lew
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin,Department of Neurosurgery, Children’s Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Michael H. Handler
- Department of Neurosurgery, Children’s Hospital Colorado, Aurora, Colorado
| | - Zulma Tovar-Spinoza
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York
| | - Matthew Smyth
- Department of Neurosurgery, St. Louis Children’s Hospital, St. Louis, Missouri
| | - Robert Bollo
- Department of Neurosurgery, Primary Children’s Hospital, Salt Lake City, Utah
| | - David Donahue
- Department of Neurosurgery, Cook Children’s Hospital, Fort Worth, Texas
| | - M. Scott Perry
- Department of Neurology, Cook Children’s Hospital, Fort Worth, Texas
| | - Michael L. Levy
- Department of Neurosurgery, Rady Children’s Hospital-San Diego, California
| | - David Gonda
- Department of Neurosurgery, Rady Children’s Hospital-San Diego, California
| | | | - Phillip B. Storm
- Department of Neurosurgery, Children’s Hospital of Philadelphia, Pennsylvania
| | - Angela V. Price
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Daniel E. Couture
- Department of Neurosurgery, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Chima Oluigbo
- Department of Neurosurgery, Children’s National Health System, Washington, DC
| | - Ann-Christine Duhaime
- Department of Neurosurgery, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Gene H. Barnett
- Department of Neurosurgery, Cleveland Clinic Children’s, Cleveland, Ohio
| | - Carrie R. Muh
- Department of Neurosurgery, Duke Children’s Hospital, Durham, North Carolina
| | - Michael D. Sather
- Department of Neurosurgery, Penn State Health, Hershey, Pennsylvania
| | - Aria Fallah
- Department of Neurosurgery, UCLA Mattel Children’s Hospital, Los Angeles, California
| | - Anthony C. Wang
- Department of Neurosurgery, UCLA Mattel Children’s Hospital, Los Angeles, California
| | - Sanjiv Bhatia
- Department of Neurosurgery, Nicklaus Children’s Hospital, Miami, Florida
| | - Kadam Patel
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sergey Tarima
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sarah Graber
- Department of Neurosurgery, Children’s Hospital Colorado, Aurora, Colorado
| | - Sean Huckins
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York
| | - Daniel M. Hafez
- Department of Neurosurgery, St. Louis Children’s Hospital, St. Louis, Missouri
| | - Kavelin Rumalla
- Department of Neurosurgery, St. Louis Children’s Hospital, St. Louis, Missouri
| | - Laurie Bailey
- Department of Neurosurgery, Cook Children’s Hospital, Fort Worth, Texas
| | - Sabrina Shandley
- Department of Neurosurgery, Cook Children’s Hospital, Fort Worth, Texas
| | - Ashton Roach
- Department of Neurosurgery, Cincinnati Children’s Hospital, Cincinnati, Ohio
| | - Erin Alexander
- Department of Neurosurgery, Children’s Hospital of Philadelphia, Pennsylvania
| | - Wendy Jenkins
- Department of Neurosurgery, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Deki Tsering
- Department of Neurosurgery, Children’s National Health System, Washington, DC
| | - George Price
- Department of Neurosurgery, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Antonio Meola
- Department of Neurosurgery, Cleveland Clinic Children’s, Cleveland, Ohio
| | - Wendi Evanoff
- Department of Neurosurgery, Cleveland Clinic Children’s, Cleveland, Ohio
| | - Eric M. Thompson
- Department of Neurosurgery, Duke Children’s Hospital, Durham, North Carolina
| | | | | |
Collapse
|
30
|
Ma J, Zhang X, Wang J, Zhou Z, Lin C. Treatment of a patient with total urinary calculi: a case report. Transl Androl Urol 2020; 8:764-769. [PMID: 32038975 DOI: 10.21037/tau.2019.11.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Urinary tract stones are a general term for stone disease in various parts of the urinary system and are common diseases of the urinary system. According to the location of the stone, it is divided into kidney stones, ureteral stones, bladder stones, urethra stones. Total urinary calculi occur less frequently, usually accompanied by severe clinical symptoms and difficult to treat. A 76-year-old man was admitted to hospital with repeated bladder stones for 7 years, repeated dysuria with frequent urination and dysuria for 2 months. After admission, the patient improved the relevant examination, and the patient was finally diagnosed with total urinary calculi combined with infection. After a series of orderly and effective treatments, especially the completion of the one-stage operation, the patient recovered smoothly and was discharged. Complicated whole-course urolithiasis is relatively rare and a single operation of total urinary calculi is feasible.
Collapse
Affiliation(s)
- Jiajia Ma
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai 264000, China
| | - Xuebao Zhang
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai 264000, China
| | - Jipeng Wang
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai 264000, China
| | - Zhongbao Zhou
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai 264000, China
| | - Chunhua Lin
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai 264000, China
| |
Collapse
|
31
|
Marra AR, Puig-Asensio M, Edmond MB, Schweizer ML, Bender D. Infectious complications of laparoscopic and robotic hysterectomy: a systematic literature review and meta-analysis. Int J Gynecol Cancer 2020; 29:518-530. [PMID: 30833440 DOI: 10.1136/ijgc-2018-000098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/07/2018] [Accepted: 12/11/2018] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE We performed a systematic review of the literature and meta-analysis of the infectious complications of hysterectomy, comparing robotic-assisted hysterectomy to conventional laparoscopic-assisted hysterectomy. METHODS We searched PubMed, CINAHL, CDSR, and EMBASE through July 2018 for studies evaluating robotic-assisted hysterectomy, laparoscopic-assisted hysterectomy, and infectious complications. We employed random-effect models to obtain pooled OR estimates. Heterogeneity was evaluated with I2 estimation and the Cochran Q statistic. Pooled ORs were calculated separately based on the reason for hysterectomy (eg, benign uterine diseases, endometrial cancer, and cervical cancer). RESULTS Fifty studies were included in the final review for the meta-analysis with 176 016 patients undergoing hysterectomy. There was no statistically significant difference in the number of infectious complication events between robotic-assisted hysterectomy and laparoscopic-assisted hysterectomy (pooled OR 0.97; 95 % CI 0.74 to 1.28). When we performed a stratified analysis, similar results were found with no statistically significant difference in infectious complications comparing robotic-assisted hysterectomy to laparoscopic-assisted hysterectomy among patients with benign uterine disease (pooled OR 1.10; 95 % CI 0.70 to 1.73), endometrial cancer (pooled OR 0.97; 95 % CI 0.55 to 1.73), or cervical cancer (pooled OR 1.09; 95 % CI 0.60 to 1.97). CONCLUSION In our meta-analysis the rate of infectious complications associated with robotic-assisted hysterectomy was no different than that associated with conventional laparoscopic-assisted hysterectomy.
Collapse
Affiliation(s)
- Alexandre R Marra
- Office of Clinical Quality, Safety and Performance Improvement University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Division of General Internal Medicine, Department of Internal Medicine, Carver College of Medicine, Iowa City, Iowa, USA
- Division of Medical Practice, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Mireia Puig-Asensio
- Office of Clinical Quality, Safety and Performance Improvement University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Division of General Internal Medicine, Department of Internal Medicine, Carver College of Medicine, Iowa City, Iowa, USA
| | - Michael B Edmond
- Office of Clinical Quality, Safety and Performance Improvement University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Division of General Internal Medicine, Department of Internal Medicine, Carver College of Medicine, Iowa City, Iowa, USA
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Marin L Schweizer
- Division of General Internal Medicine, Department of Internal Medicine, Carver College of Medicine, Iowa City, Iowa, USA
- The Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA
| | - David Bender
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| |
Collapse
|
32
|
Xia H, Zhu D, Li J, Sun Z, Deng L, Zhu P, Zhang Y, Li X, Wang D. Current status and research progress of minimally invasive surgery for flail chest. Exp Ther Med 2019; 19:421-427. [PMID: 31885692 PMCID: PMC6913304 DOI: 10.3892/etm.2019.8264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 09/25/2019] [Indexed: 01/27/2023] Open
Abstract
Chest trauma accounts for ~13.5% of all traumas, and direct death from chest trauma accounts for 20–25% of all traumatic deaths. Chest trauma is the second cause of death from trauma. Frequent rib fractures, especially in patients with flail chest, often cause severe pain, chest wall softening, abnormal breathing and severe lung contusion and laceration, usually requiring thoracic surgery. In recent years, the open reduction and internal fixation treatment of rib fractures with flail chest has achieved satisfactory results, and some surgical indications have reached consensus. A number of scholars and medical centers have demonstrated the practicality and cost-effectiveness of rib fixation in flail chest, including the small incidence of pulmonary complications, the short ICU mechanical ventilation time, and the reduction of digestive tract inhibition. Open reduction and internal fixation of rib fractures involves multiple ribs. Conventional rib fractures require a large incision to achieve satisfactory exposure. Chest wall muscles, blood vessels and nerves (long thoracic and thoracodorsal nerves) are injured, resulting in a high infection rate of the incision and postoperative dysfunctions, such as limited upper limb, shoulder and back function, and long time numbness on the affected side of the chest. Therefore, the damage of muscles and nerves caused by conventional surgical methods limits the development of such surgical technique. Although the video-assisted thoracoscopic technique has become a necessary technical means for the treatment of thoracic trauma and has been applied to thoracic exploration and hemostasis, there is no report on the application of open reduction and internal fixation for rib fracture. The difficulty lies in the tightly combined bony thorax and the soft tissue of the chest wall. Therefore, experts have explored a variety of minimally invasive surgical methods for the flail chest. The current status and research progress of minimally invasive surgery for thoracic surgery are reviewed.
Collapse
Affiliation(s)
- Honggang Xia
- Department of Cardiothoracic Surgery, Tianjin Hospital Affiliated to Tianjin University, Tianjin 300000, P.R. China.,School of Medical Engineering and Translational Medicine, Tianjin 300000, P.R. China
| | - Deqing Zhu
- Department of Cardiothoracic Surgery, Tianjin Hospital Affiliated to Tianjin University, Tianjin 300000, P.R. China
| | - Jing Li
- Teaching and Research Division, Tianjin Medical College, Tianjin 300000, P.R. China
| | - Zhongyi Sun
- Department of Cardiothoracic Surgery, Tianjin Hospital Affiliated to Tianjin University, Tianjin 300000, P.R. China
| | - Limin Deng
- Department of Cardiothoracic Surgery, Tianjin Hospital Affiliated to Tianjin University, Tianjin 300000, P.R. China
| | - Pengzhi Zhu
- Department of Cardiothoracic Surgery, Tianjin Hospital Affiliated to Tianjin University, Tianjin 300000, P.R. China
| | - Yongmin Zhang
- Department of Cardiothoracic Surgery, Tianjin Hospital Affiliated to Tianjin University, Tianjin 300000, P.R. China
| | - Xuan Li
- Department of Cardiothoracic Surgery, Tianjin Hospital Affiliated to Tianjin University, Tianjin 300000, P.R. China
| | - Dongbin Wang
- Department of Cardiothoracic Surgery, Tianjin Hospital Affiliated to Tianjin University, Tianjin 300000, P.R. China
| |
Collapse
|
33
|
Vass G, Bere Z, Szabó D, Rovó L. [Nasolabial suspension of the malar fat pad: a new, minimally invasive and reversible technique for facial symmetrization in permanent facial paralysis]. Orv Hetil 2019; 160:869-872. [PMID: 31131610 DOI: 10.1556/650.2019.31344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Introduction: For the treatment of asymmetry of the midface due to permanent peripheral facial nerve palsy of different etiologies - which means a great psychical burden for the patients - several surgical solutions have been described. Aim: Our goal was to elaborate a minimally invasive surgical technique, that, on one hand, restores an adequate nasolabial fold, which is the most determinative keystone of facial symmetry. On the other hand, our technique can give an appropriate lift for the malar fat pad with shorter operative time and burden, with much lower complication rate and shorter recovery period compared to the classic static sling suspension techniques. Method: Out method is based on the formation of a neo-nasolabial fold, which is then suspended to the temporal fascia by permanent threads thus restoring facial symmetry and giving a lifting effect on the midfacial soft tissues as well. Results: Between 2014 and 2017, six patients had been operated with this nasolabial lifting technique of the malar fat pad without any major complications under local anesthesia on an outpatient basis at our Department. Conclusions: As our surgical exploration is minimal, the postoperative period is shorter, no visible scars remain on the face and the complication rate is negligible. If necessary, suspension could easily be adjusted, and as the technique is reversible, no other possible facial reconstruction methods are excluded. Our method can symmetrize the face in resting position completely on the long term, which is the most important issue for our patients according to their feedback. Orv Hetil. 2019; 160(22): 869-872.
Collapse
Affiliation(s)
- Gábor Vass
- Fül-Orr-Gégészeti és Fej-Nyaksebészeti Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Tisza L. krt. 111., 6725
| | - Zsófia Bere
- Fül-Orr-Gégészeti és Fej-Nyaksebészeti Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Tisza L. krt. 111., 6725
| | - Diána Szabó
- Fül-Orr-Gégészeti és Fej-Nyaksebészeti Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Tisza L. krt. 111., 6725
| | - László Rovó
- Fül-Orr-Gégészeti és Fej-Nyaksebészeti Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Tisza L. krt. 111., 6725
| |
Collapse
|
34
|
Agarwal MC, Rathore P, Gummaluri SS, Agarwal P, Kumari S. Vestibular Incision Subperiosteal Tunnel Access with Titanium-Prepared Platelet-Rich Fibrin - A Golden Approach for Treating Multiple Recession Defects in Esthetic Zone. Contemp Clin Dent 2019; 10:682-685. [PMID: 32792832 PMCID: PMC7390423 DOI: 10.4103/ccd.ccd_2_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Gingival recession is defined as apical migration of marginal gingival tissue causing the exposure of root surface. Abnormal brushing techniques, trauma, anatomical presence of tooth, caries, and improper oral hygiene measures are some of the problems leading to gingival recession. Several treatment modalities such as coronary advanced flaps and free gingival grafts have been used for the treatment of gingival recession defects and showed good results. However, while treating multiple gingival recessions, some new treatment modalities were introduced in literature. Vestibular incision subperiosteal tunnel access (VISTA) as a minimally invasive technique for root coverage was introduced with various advantages such as no secondary surgical site needed for harvestment of donor tissue and it provides excellent esthetic results with decreased patient morbidity. The present case report emphasizes on the treatment of multiple gingival recessions in the maxillary anterior teeth region using VISTA with titanium-prepared platelet-rich fibrin.
Collapse
Affiliation(s)
- Manvi Chandra Agarwal
- Department of Periodontology and Implantology, Institute of Dental Sciences, Bareilly, Uttar Pradesh, India
| | - Priyansha Rathore
- Department of Periodontology and Implantology, Institute of Dental Sciences, Bareilly, Uttar Pradesh, India
| | - Shiva Shankar Gummaluri
- Department of Periodontology and Implantology, Institute of Dental Sciences, Bareilly, Uttar Pradesh, India
| | - Prerna Agarwal
- Department of Periodontology and Implantology, Institute of Dental Sciences, Bareilly, Uttar Pradesh, India
| | - Sanju Kumari
- Department of Periodontology and Implantology, Institute of Dental Sciences, Bareilly, Uttar Pradesh, India
| |
Collapse
|
35
|
Marra AR, Puig-Asensio M, Edmond MB, Schweizer ML, Nepple KG. Infectious Complications of Conventional Laparoscopic vs Robotic Laparoscopic Prostatectomy: A Systematic Literature Review and Meta-Analysis. J Endourol 2019; 33:179-188. [PMID: 30632396 DOI: 10.1089/end.2018.0815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Recent studies have shown that using minimally invasive surgical techniques (conventional laparoscopy or robotic) for prostatectomy is associated with lower perioperative complication rates compared with open radical retropubic prostatectomy. However, differences in infectious complications between these minimally invasive approaches are not well characterized. To study this further, we performed a systematic review of the literature and meta-analysis of the infectious complications of prostatectomy, comparing robotic prostatectomy (RP) with conventional laparoscopic prostatectomy (LP). METHODS We searched PubMed, CINAHL, CDSR, and EMBASE through September 2018 for studies evaluating minimally invasive prostatectomy and infectious complications. We employed random-effect models to obtain pooled odds ratio (pOR) estimates. Heterogeneity was evaluated with I2 estimation and the Cochran Q statistic. pORs were calculated separately based on the indication for prostatectomy. RESULTS Fifteen studies were included in the final review for the meta-analysis with 14,121 patients undergoing minimally invasive prostatectomy. There was no statistically significant difference in the number of infectious complication events between RP and LP (pOR 0.94; 95% CI 0.50, 1.76). When we performed a stratified analysis, similar results were found with no statistically significant difference in infectious complications comparing RP with LP among patients with prostate cancer (pOR 0.73; 95% CI 0.43, 1.24). We observed that infectious complications were nearly threefold higher with the robotic approach in earlier studies (published between 2007 and 2012, pOR 2.81; 95% CI 1.07, 7.39), but no significant difference was found in later studies (between 2013 and 2018, pOR 0.80, 95% CI 0.40, 1.57). CONCLUSIONS The rate of infectious complications associated with RP was no different than that associated with conventional LP.
Collapse
Affiliation(s)
- Alexandre R Marra
- 1 Office of Clinical Quality, Safety and Performance Improvement, University of Iowa Hospitals and Clinics, Iowa City, Iowa.,2 Division of General Internal Medicine, Department of Internal Medicine, Carver College of Medicine, Iowa City, Iowa.,3 Division of Medical Practice, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Mireia Puig-Asensio
- 1 Office of Clinical Quality, Safety and Performance Improvement, University of Iowa Hospitals and Clinics, Iowa City, Iowa.,2 Division of General Internal Medicine, Department of Internal Medicine, Carver College of Medicine, Iowa City, Iowa
| | - Michael B Edmond
- 1 Office of Clinical Quality, Safety and Performance Improvement, University of Iowa Hospitals and Clinics, Iowa City, Iowa.,2 Division of General Internal Medicine, Department of Internal Medicine, Carver College of Medicine, Iowa City, Iowa.,4 Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Marin L Schweizer
- 2 Division of General Internal Medicine, Department of Internal Medicine, Carver College of Medicine, Iowa City, Iowa.,5 The Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
| | - Kenneth G Nepple
- 6 Department of Urology, University of Iowa Carver College of Medicine, Iowa City, Iowa
| |
Collapse
|
36
|
Abstract
BACKGROUND: Following failure of conservative treatment, a dorsal cheilectomy can be performed for patients in early stages of hallux rigidus by a traditional open approach or by a minimally invasive technique. We report our clinical outcomes following minimally invasive dorsal cheilectomy (MIDC). METHODS: Eighty-nine patients (98 feet) with symptomatic hallux rigidus treated between 2011 and 2016 were included in this study. The average age was 54 years. Manchester-Oxford Foot Questionnaire (MOxFQ) scores and visual analog scale (VAS) pain scores were collected. The mean follow-up was 50 months. RESULTS: The average VAS score improved from 8.0 preoperatively to 3 postoperatively. The mean MOxFQ summary index score decreased from 58.6 preoperatively to 30.5 postoperatively. All 3 MOxFQ domains also improved. Swelling took an average of 5.3 weeks to settle. There were 2 wound infections and 2 delayed wound healings. Two patients had transient nerve paraesthesia, while 2 patients had permanent numbness in the dorsomedial cutaneous nerve distribution. Twelve patients (12%) underwent reoperation, of which 7 had a first metatarsophalangeal joint arthrodesis for ongoing pain, 4 had repeat cheilectomy for residual impingement, and 1 had an open removal of loose bone. CONCLUSION: Our results suggest that MIDC resulted in improvement in patient-reported outcome measures and was a safe technique with minimal complications. The complications were similar to open cheilectomy. There was an associated learning curve as 5 of our reoperations were due to incomplete cheilectomy. Coughlin grade 1 did well with MIDC as with open cheilectomy as none went onto an arthrodesis. However, 10% (7/65) of our grade 2 and 3 cases went on to an arthrodesis. LEVEL OF EVIDENCE: Level IV, retrospective case series.
Collapse
Affiliation(s)
- Kar Hao Teoh
- 1 Foot and Ankle Unit, Royal Gwent Hospital, Newport, UK
| | - Wei Teen Tan
- 1 Foot and Ankle Unit, Royal Gwent Hospital, Newport, UK
| | - Zeid Atiyah
- 1 Foot and Ankle Unit, Royal Gwent Hospital, Newport, UK
| | - Aziz Ahmad
- 1 Foot and Ankle Unit, Royal Gwent Hospital, Newport, UK
| | - Hiro Tanaka
- 1 Foot and Ankle Unit, Royal Gwent Hospital, Newport, UK
| | | |
Collapse
|
37
|
Oliveira AI, Barroso C, Osório A, Correia-Pinto J. Minimally Invasive Surgical Treatment of Pilonidal Disease: Mid-Term Retrospective Analysis of a Single Center. Front Pediatr 2019; 7:215. [PMID: 31214552 PMCID: PMC6558067 DOI: 10.3389/fped.2019.00215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 05/14/2019] [Indexed: 12/31/2022] Open
Abstract
Background: Sacrococcygeal Pilonidal Disease (PD) is commonly treated with excision and primary closure techniques (EPC). Minimally invasive techniques (MIT), such as EPSiT and Pit-picking, had been recently advocated promising better outcomes. We analyzed mid-term results from our center after introduction of MIT to treat PD. Methods: Patients submitted to MIT (n = 44) with a median follow-up of 37 months were analyzed and compared with patients submitted to EPC (n = 70) with a median follow-up of 5 years. Both groups included patients operated in our department between 2011 and 2016 and have similar demographic and clinical characteristics. We compared operative time and post-operative parameters such as time with pain, dressing time and time to relapse. Results: The post-operative time with pain was significantly lower, whereas the dressing time was significantly longer, in MIT when compared to the EPC group. The relapse rate was similar in both groups but the follow-up is shorter in the MIT group. In addition, the analysis of patients free of disease using Kaplan-Meier curves revealed that relapse tends to occur more precociously in MIT than in EPC patients (p = 0.014). Interestingly, in the subgroup of patients with previous surgery, MIT's relapse rate was significantly lower than in the EPC group (30 vs. 100%, p < 0.001). Conclusions: MIT has the advantage of having a shorter time with pain in the postoperative period, while EPC benefits from a shorter dressing time. In general, the relapse of the disease tends to manifest more precociously in MIT patients. Moreover, in the subgroup of patients with previous surgery, MIT seems to have significantly better results when compared to EPC.
Collapse
Affiliation(s)
- Ana Isabel Oliveira
- Department of Pediatric Surgery, Hospital de Braga, Braga, Portugal.,School of Medicine, Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Catarina Barroso
- Department of Pediatric Surgery, Hospital de Braga, Braga, Portugal.,School of Medicine, Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Angélica Osório
- Department of Pediatric Surgery, Hospital de Braga, Braga, Portugal
| | - Jorge Correia-Pinto
- Department of Pediatric Surgery, Hospital de Braga, Braga, Portugal.,School of Medicine, Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| |
Collapse
|
38
|
Scorza D, Amoroso G, Cortés C, Artetxe A, Bertelsen Á, Rizzi M, Castana L, De Momi E, Cardinale F, Kabongo L. Experience-based SEEG planning: from retrospective data to automated electrode trajectories suggestions. Healthc Technol Lett 2018; 5:167-171. [PMID: 30464848 PMCID: PMC6222245 DOI: 10.1049/htl.2018.5075] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 08/20/2018] [Indexed: 01/21/2023] Open
Abstract
StereoElectroEncephaloGraphy (SEEG) is a minimally invasive technique that consists of the insertion of multiple intracranial electrodes to precisely identify the epileptogenic focus. The planning of electrode trajectories is a cumbersome and time-consuming task. Current approaches to support the planning focus on electrode trajectory optimisation based on geometrical constraints but are not helpful to produce an initial electrode set to begin with the planning procedure. In this work, the authors propose a methodology that analyses retrospective planning data and builds a set of average trajectories, representing the practice of a clinical centre, which can be mapped to a new patient to initialise planning procedure. They collected and analysed the data from 75 anonymised patients, obtaining 30 exploratory patterns and 61 mean trajectories in an average brain space. A preliminary validation on a test set showed that they were able to correctly map 90% of those trajectories and, after optimisation, they have comparable or better values than manual trajectories in terms of distance from vessels and insertion angle. Finally, by detecting and analysing similar plans, they were able to identify eight planning strategies, which represent the main tailored sets of trajectories that neurosurgeons used to deal with the different patient cases.
Collapse
Affiliation(s)
- Davide Scorza
- e-Health and Biomedical Applications Department, Vicomtech, Donostia-San Sebastián, Spain.,Dipartimento di Elettronica, Informazione e Bioingegneria (DEIB), Politecnico di Milano, Milan, Italy
| | - Gaetano Amoroso
- Dipartimento di Elettronica, Informazione e Bioingegneria (DEIB), Politecnico di Milano, Milan, Italy
| | - Camilo Cortés
- e-Health and Biomedical Applications Department, Vicomtech, Donostia-San Sebastián, Spain
| | - Arkaitz Artetxe
- e-Health and Biomedical Applications Department, Vicomtech, Donostia-San Sebastián, Spain
| | - Álvaro Bertelsen
- e-Health and Biomedical Applications Department, Vicomtech, Donostia-San Sebastián, Spain
| | - Michele Rizzi
- Claudio Munari Centre for Epilepsy and Parkinson Surgery, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Laura Castana
- Claudio Munari Centre for Epilepsy and Parkinson Surgery, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Elena De Momi
- Dipartimento di Elettronica, Informazione e Bioingegneria (DEIB), Politecnico di Milano, Milan, Italy
| | - Francesco Cardinale
- Claudio Munari Centre for Epilepsy and Parkinson Surgery, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Luis Kabongo
- e-Health and Biomedical Applications Department, Vicomtech, Donostia-San Sebastián, Spain
| |
Collapse
|
39
|
Miladi L, Gaume M, Khouri N, Johnson M, Topouchian V, Glorion C. Minimally Invasive Surgery for Neuromuscular Scoliosis: Results and Complications in a Series of One Hundred Patients. Spine (Phila Pa 1976) 2018; 43:E968-E975. [PMID: 29419720 PMCID: PMC6080881 DOI: 10.1097/brs.0000000000002588] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 11/20/2017] [Accepted: 01/05/2018] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective review. OBJECTIVE To report the results of an alternative technique using a minimally invasive fusionless surgery. The originality is based on the progressive correction of the deformities with proximal and distal fixation and on the reliability of the pelvic fixation using iliosacral screws on osteoporotic bones. SUMMARY OF BACKGROUND DATA Spinal deformities are common in neuromuscular diseases. Conventional treatment involves bracing, followed by spinal instrumented fusion. Growing rod techniques are increasingly advocated but have a high rate of complications. METHODS The technique relies on a bilateral double rod sliding construct anchored proximally by four hooks claws and distally to the pelvis by iliosacral screws through a minimally invasive approach. Hundred patients with neuromuscular scoliosis underwent the same fusionless surgery extended from T1 to the pelvis. The average age at initial surgery was 11 + 6 years. Diagnoses included cerebral palsy (61), spinal muscular atrophy (22), muscular dystrophy (10), and other neurological etiologies (7). Cobb angle and pelvic obliquity were measured before and after initial surgery, and at final follow-up. Complications were reviewed. RESULTS At latest follow-up 3 + 9 years (range 2 yr-6 + 3 yr), the mean Cobb angle improved from 89° to 35° which corresponds to 61% correction. Mean pelvic obliquity improved from 29° to 5°, which corresponds to 83% correction. Mean T1-S1 length increased from 30.02 to 37.28 cm. Mean preoperative hyper kyphosis was reduced from 68.44° to 33.29°. Complications occurred in 26 patients including mechanical complications (12) and wound infections (16). No arthrodesis was required at last follow-up. CONCLUSION This original fusionless technique is safe and effective, preserving spinal and thoracic growth. It provides a significant correction of spinal deformities and pelvic obliquity with a reduced complications rate. The strength and stability of this modular construct over time allow the avoidance of final arthrodesis. LEVEL OF EVIDENCE 4.
Collapse
Affiliation(s)
- Lotfi Miladi
- Pediatrics Orthopedics Department, Necker Hospital, Paris Descartes University, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Mathilde Gaume
- Pediatrics Orthopedics Department, Necker Hospital, Paris Descartes University, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Nejib Khouri
- Pediatrics Orthopedics Department, Necker Hospital, Paris Descartes University, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Michael Johnson
- Pediatrics Orthopedics Department, The Royal Children's Hospital, Melbourne, Australia
| | - Vicken Topouchian
- Pediatrics Orthopedics Department, Necker Hospital, Paris Descartes University, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Christophe Glorion
- Pediatrics Orthopedics Department, Necker Hospital, Paris Descartes University, Assistance Publique Hôpitaux de Paris, Paris, France
| |
Collapse
|
40
|
Wang XJ. [Application of minimally invasive cosmetic dentistry in the clinics of pediatric dentistry]. Hua Xi Kou Qiang Yi Xue Za Zhi 2018; 36:349-354. [PMID: 30182559 DOI: 10.7518/hxkq.2018.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
With the minimally invasive treatment attracting considerable attention in the field of dentistry, a series of oral minimally invasive treatment technologies, including minimally invasive cosmetic dentistry (MICD) technology, is emerging. Children, as a special group of patients, are in the critical stage of the initial formation of psychological structure. Therefore, children's dental treatment should not be limited to restoring function and relieving pain. The development, aesthetics, and physical and mental health should also be given attention. Therefore, in recent years, MICD technology has been widely used in diagnosis and treatment of pediatric dentistry. This review provides a detailed introduction regarding a series of techniques in pediatric dentistry.
Collapse
Affiliation(s)
- Xiao-Jing Wang
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shanxi Clinical Research Center for Oral Diseases, Dept. of Pediatric Dentistry, School of Stomatology, Air Force Medical University, Xi'an 710032, China
| |
Collapse
|
41
|
Majeed H, Barrie J, Munro W, McBride D. Minimally invasive reduction and percutaneous fixation versus open reduction and internal fixation for displaced intra-articular calcaneal fractures: A systematic review of the literature. EFORT Open Rev 2018; 3:418-425. [PMID: 30233817 PMCID: PMC6129959 DOI: 10.1302/2058-5241.3.170043] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of this article is to systematically identify and analyse research evidence available to compare the outcomes of minimally invasive reduction and percutaneous fixation (MIRPF) versus open reduction and internal fixation (ORIF) for displaced intra-articular calcaneal fractures. Articles from 2000 to 2016 were searched through MEDLINE (PubMed), Cochrane Library, Embase, ScienceDirect, Scopus and ISI Web of Knowledge using Boolean logic and text words. Of the 570 articles identified initially, nine were selected including three randomized controlled trials and six retrospective comparative studies. All nine studies had a total of 1031 patients with 1102 displaced intra-articular calcaneal fractures. Mean follow-up was 33 months. Of these, 602 (54.6%) were treated with MIRPF and 500 (45.4%) were treated with ORIF. Overall incidence of wound-related complications in patients treated with MIRPF was 4.3% (0% to 13%) compared with 21.2% (11.7% to 35%) in the ORIF group Functional outcomes were reported to be better in the minimally invasive group in all studies; however, the results did not reach statistical significance in some studies. All the studies had methodological flaws that put them at either ‘unclear’ or ‘high’ risk of bias for multiple domains. Overall quality of the available evidence is poor in support of either surgical technique due to small sample size, flaws in study designs and high risk of bias for various elements. Individual studies have reported minimally invasive techniques to be an effective alternative with lower risk of wound complications and better functional outcomes.
Cite this article: EFORT Open Rev 2018;3:418-425. DOI: 10.1302/2058-5241.3.170043
Collapse
|
42
|
Cai P, Kong Q, Song Y. [Short-term effectiveness of percutaneous endoscopic lumbar discectomy in treatment of buttock pain associated with lumbar disc herniation]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2018; 32:673-677. [PMID: 29905043 DOI: 10.7507/1002-1892.201712015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective To evaluate the short-term effectiveness of percutaneous endoscopic lumbar discectomy (PELD) in treatment of buttock pain associated with lumbar disc herniation. Methods Between June 2015 and May 2016, 36 patients with buttock pain associated with lumbar disc herniation were treated with PELD. Of 36 cases, 26 were male and 10 were female, aged from 18 to 76 years (mean, 35.6 years). The disease duration ranged from 3 months to 10 years (mean, 14 months). The location of the pain was buttock in 2 cases, buttock and thigh in 6 cases, buttock and the ipsilateral lower extremity in 28 cases. Thirty-four patients had single-level lumbar disc herniation, and the involved segments were L 4, 5 in 15 cases and L 5, S 1 in 19 cases; 2 cases had lumbar disc herniation at both L 4, 5 and L 5, S 1. The preoperative visual analogue scale (VAS) score of buttock pain was 6.1±1.3. VAS score was used to evaluate the degree of buttock pain at 1 month, 3 months, 6 months, and last follow-up postoperatively. The clinical outcome was assessed by the modified MacNab criteria at last follow-up. Results All patients were successfully operated and the operation time was 27-91 minutes (mean, 51 minutes). There was no nerve root injury, dural tear, hematoma formation, or other serious complications. The hospitalization time was 3-8 days (mean, 5.3 days). All incisions healed well and no infection occurred. Patients were followed up 12-24 months (median, 16 months). MRI examination results showed that the dural sac and nerve root compression were sufficiently relieved at 3 months after operation. Patients obtained pain relief after operation. The postoperative VAS scores of buttock pain at 1 month, 3 months, 6 months, and last follow-up were 1.1±0.6, 0.9±0.3, 1.0±0.3, and 0.9±0.4 respectively, showing significant differences when compared with preoperative VAS scores ( P<0.05); there was no significant difference in VAS score between the different time points after operation ( P>0.05). At last follow-up, according to the modifed MacNab criteria, the results were excellent in 27 cases, good in 9 cases, and fair in 2 cases, and the excellent and good rate was 94.4%. Conclusion PELD can achieve satisfactory short-term results in the treatment of buttock pain associated with lumbar disc herniation and it is a safe and effective minimally invasive surgical technique.
Collapse
Affiliation(s)
- Peng Cai
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Qingquan Kong
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041,
| | - Yueming Song
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| |
Collapse
|
43
|
Olmi S, Giorgi R, Cioffi SPB, Uccelli M, Villa R, Ciccarese F, Scotto B, Castello G, Legnani G, Cesana G. Total and Subtotal Laparoscopic Gastrectomy for the Treatment of Advanced Gastric Cancer: Morbidity and Oncological Outcomes. J Laparoendosc Adv Surg Tech A 2017; 28:278-285. [PMID: 29135363 DOI: 10.1089/lap.2017.0372] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND A debate is still surrounding the use of laparoscopic surgery for advanced gastric cancer (AGC) related to doubts about the requirements to satisfy oncologic criteria. The aim of this study is to analyze the oncological results, the intraoperative complications, and the short- and medium-term morbidity and mortality in patients with AGC who underwent subtotal laparoscopic gastrectomy (SLG) or total laparoscopic gastrectomy (TLG) with extended lymphadenectomy. MATERIALS AND METHODS We reviewed medical records of patients who underwent radical gastrectomy for AGC started laparoscopically with the intent of curative surgery, between July 2007 and October 2015. We recruited 74 patients and studied demographics, American Society of Anesthesiologists (ASA) score, pTNM stage, histologic pattern of the tumor, duration of surgery, conversion rate, estimated blood loss, number of resected lymph nodes, type of gastrointestinal reconstruction, postoperative complication, mortality rate, length of stay, time to canalization and resumption of food intake, and overall and disease-free survival rate. RESULTS We performed 74 interventions, with a conversion rate of 14.9% (11/74). Sixty-three were performed totally as laparoscopic: 43 (68.25%) SLGs and 20 (31.75%) TLGs, all with an extended lymphadenectomy (D2 or more). Operative time was 150 ± 34 minutes (range 75-225 minutes), the mean number of resected lymph nodes 21.4 ± 6.2, global morbidity rate 25.39%, rate of reoperation 9.52%, and perioperative mortality at 30 days 0%. We performed an average follow-up of 48.7 months (range 18-60), and we observed 5-year overall and disease-free survival, respectively, of 48.6% and 42.7%. CONCLUSIONS LG with extended lymphadenectomy for AGC is a feasible procedure with good results in terms of postoperative course, complications, and mortality. Thanks to the use of extremely precise and safe technologies the extended lymphadenectomy can be performed laparoscopically. The laparoscopic approach, when performed by experienced surgeons, ensures a correct oncological treatment in combination with the benefits of the laparoscopic technique.
Collapse
Affiliation(s)
- Stefano Olmi
- 1 Department of Surgery, Policlinico San Marco , Zingonia-Osio Sotto, Bergamo, Italy .,2 School of General Surgery, University of Milan , Milano, Italy
| | - Riccardo Giorgi
- 1 Department of Surgery, Policlinico San Marco , Zingonia-Osio Sotto, Bergamo, Italy
| | - Stefano Piero Bernardo Cioffi
- 1 Department of Surgery, Policlinico San Marco , Zingonia-Osio Sotto, Bergamo, Italy .,2 School of General Surgery, University of Milan , Milano, Italy
| | - Matteo Uccelli
- 1 Department of Surgery, Policlinico San Marco , Zingonia-Osio Sotto, Bergamo, Italy
| | - Roberta Villa
- 1 Department of Surgery, Policlinico San Marco , Zingonia-Osio Sotto, Bergamo, Italy
| | - Francesca Ciccarese
- 1 Department of Surgery, Policlinico San Marco , Zingonia-Osio Sotto, Bergamo, Italy .,2 School of General Surgery, University of Milan , Milano, Italy
| | - Bruno Scotto
- 1 Department of Surgery, Policlinico San Marco , Zingonia-Osio Sotto, Bergamo, Italy
| | - Giorgio Castello
- 1 Department of Surgery, Policlinico San Marco , Zingonia-Osio Sotto, Bergamo, Italy
| | - Gianluca Legnani
- 1 Department of Surgery, Policlinico San Marco , Zingonia-Osio Sotto, Bergamo, Italy
| | - Giovanni Cesana
- 1 Department of Surgery, Policlinico San Marco , Zingonia-Osio Sotto, Bergamo, Italy .,2 School of General Surgery, University of Milan , Milano, Italy
| |
Collapse
|
44
|
Abstract
This study aimed to compare the efficacy of muscle gap approach under a minimally invasive channel surgical technique with the traditional median approach.In the Orthopedics Department of Traditional Chinese and Western Medicine Hospital, Tongzhou District, Beijing, 68 cases of lumbar spinal canal stenosis underwent surgery using the muscle gap approach under a minimally invasive channel technique and a median approach between September 2013 and February 2016. Both approaches adopted lumbar spinal canal decompression, intervertebral disk removal, cage implantation, and pedicle screw fixation. The operation time, bleeding volume, postoperative drainage volume, and preoperative and postoperative visual analog scale (VAS) score and Japanese Orthopedics Association score (JOA) were compared between the 2 groups.All patients were followed up for more than 1 year. No significant difference between the 2 groups was found with respect to age, gender, surgical segments. No diversity was noted in the operation time, intraoperative bleeding volume, preoperative and 1 month after the operation VAS score, preoperative and 1 month after the operation JOA score, and 6 months after the operation JOA score between 2 groups (P > .05). The amount of postoperative wound drainage (260.90 ± 160 mL vs 447.80 ± 183.60 mL, P < .001) and the VAS score 6 months after the operation (1.71 ± 0.64 vs 2.19 ± 0.87, P = .01) were significantly lower in the muscle gap approach group than in the median approach group (P < .05). In the muscle gap approach under a minimally invasive channel group, the average drainage volume was reduced by 187 mL, and the average VAS score 6 months after the operation was reduced by an average of 0.48.The muscle gap approach under a minimally invasive channel technique is a feasible method to treat long segmental lumbar spinal canal stenosis. It retains the integrity of the posterior spine complex to the greatest extent, so as to reduce the adjacent spinal segmental degeneration and soft tissue trauma. Satisfactory short-term and long-term clinical results were obtained.
Collapse
Affiliation(s)
- Yang Bin
- Department of Orthopedics, Traditional Chinese and Western Medicine Hospital in Tongzhou District, Beijing University of Chinese Medicine
| | - Wang De cheng
- Department of Orthopedics, Traditional Chinese and Western Medicine Hospital in Tongzhou District, Capital Medical University
| | - Wang Zong wei
- Department of Orthopedics, Traditional Chinese and Western Medicine Hospital in Tongzhou District, North China Coal Medical College, Beijing
| | - Li Hui
- Department of Orthopedics, Xi’an Red Cross Hospital, Union Medical College, Xi’an, China
| |
Collapse
|
45
|
Račkauskas R, Mikalauskas S, Petrulionis M, Poškus T, Jotautas V, Stanaitis J, Poškus E, Strupas K. Laparoscopically assisted colonoscopic polypectomy - viable option for curative surgery in elderly patients. Wideochir Inne Tech Maloinwazyjne 2017; 12:120-4. [PMID: 28694896 DOI: 10.5114/wiitm.2017.68138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 04/14/2017] [Indexed: 11/19/2022] Open
Abstract
Introduction Colorectal cancer (CRC) is the third most common cancer worldwide and the fourth most frequent cause of cancer-related death in the world. CRC screening programs have been widely introduced worldwide, allowing for early detection and removal of precancerous lesions and avoiding major surgical intervention. However, not all polyps are suitable for conventional and advanced colonoscopic polypectomy. Thus, laparoscopically assisted colonoscopic polypectomy (LACP) was introduced to clinical practice as a method of choice for these polyps and adenomas. Aim To overlook our experience in laparoscopically assisted colonoscopic polypectomies and evaluate effectiveness and quality of the procedure. Material and methods A retrospective analysis of a prospectively maintained database was performed. using the Vilnius University Hospital Santariskiu Klinikos patient database for the period from 2010 to 2016, resulting in 21 cases in which LACP was performed. All procedures were performed using combined laparoscopy and videocolonoscopy techniques. Morphology of adenomas was classified according to the Paris classification during the procedure. Creation of the database was approved by the Lithuanian Bioethics committee. Results Twenty-two adenomas were removed from 21 patients, aged 65.33 ±8.9. There was no difference between male and female age, but occurrence of adenomas in females was 2-fold higher. The majority of removed lesions were localized in the cecum and mean size was 27.2 ±11.1 mm. The morphology of adenomas was distributed equally between 0–Is, 0–Ip, and 0–IIa, except one, which belonged to 0–III. Histological analysis revealed that tubulovillous adenoma occurrence was 1.4 times higher than tubulous adenoma. There was only one postoperative complication – bleeding from the adenoma resection site, which was managed by conservative means. One patient developed G2 adenocarcinoma at the polyp resection site and was referred for radical surgery. Conclusions The LACP is a safe procedure with minimal risk to the elderly patient. Patient follow-up is essential for detection of recurrence.
Collapse
|
46
|
Zil-E-Ali A, Assad S, Jabbar F. Simultaneous Robot-assisted Laparoscopic Excision of Pre-pyloric Gastrointestinal Stromal Tumor and Cholecystectomy. Cureus 2017; 9:e1306. [PMID: 28690940 PMCID: PMC5493468 DOI: 10.7759/cureus.1306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Operating on more than a single procedure in a same surgical intervention saves time, anesthesia duration and can increase the overall quality of life by lowering the duration of hospital stay and minimizing patient anxiety. But such interventions require expertise, high surgical performance, and precision in anatomical manipulation. We present a case of an outstanding performance of a unique minimally invasive simultaneous approach of removing a pre-pyloric gastrointestinal stromal tumor (GIST) along with a cholecystectomy by a robot-assisted laparascopic surgical system. So far, only 33 cases of GIST have been reported in literature that were managed by robot-assistance, and this case is the first of its kind. This is the case of a 60-year-old overweight female who presented for a follow-up for chest discomfort, shortness of breath, chronic gastric reflux and classical features of cholecystitis along with diarrheal and constipation episodes. A gastroduodenoscopy showed a mass in the pre-pyloric area that extended in the luminal cavity. A robot-assisted laparascopic approach was planned, and with precision and surgical expertise the mass was removed along with a cholecystectomy. The surgical specimen were confirmed on histopathology.
Collapse
Affiliation(s)
| | - Salman Assad
- Department of Medicine, Shifa International Hospital, Islamabad, Pakistan
| | - Furrukh Jabbar
- Department of General, Colorectal & Hepato Pancreatico Biliary Surgery, Appalachian Regional Healthcare, Hazard, Kentucky, Us
| |
Collapse
|
47
|
Dong F, Lu C, Zhu J, Li Y, Mi K. [Minimally invasive treatment of calcaneal fractures by subtalar arthroscopy with posterior approach]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2017; 31:36-41. [PMID: 29798626 DOI: 10.7507/1002-1892.201608001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To evaluate the results of arthroscopically-assisted closed reduction and percutaneous screw fixation by posterior approach to subtalar joint for calcaneal fractures of Essex-Lopresti tongue type, Sanders IIA, IIB, and IIIAB. Methods Sixteen patients with unilateral calcaneal fracture were treated with arthroscopically-assisted closed reduction and percutaneous screw fixation by posterior approach to subtalar joint between June 2012 and June 2015. There were 13 males and 3 females with an average age of 37.8 years (range, 18-65 years). The injury causes included falling from height in 10 cases and traffic accident in 6 cases. Of 16 cases, 4 were classified as Essex-Lopresti tongue type, 5 as Sanders IIA, 4 as Sanders IIB, and 3 as Sanders IIIAB. The interval of injury and operation was 4-8 days (mean, 5.94 days). The Böhler angle, Gissane angle, and width of calcaneus were measured before and after operation. American Orthopaedic Foot and Ankle Society (AOFAS) score was used to evaluate the ankle function at 12 months after operation. Results Primary healing of incision was obtained in all cases, and no complications of infection, necrosis, and osseous fascia compartment syndrome occurred. The patients were followed up 12-15 months (mean, 13.63 months). The X-ray films showed that fracture line disappeared at 6 months after operation; the patients had no tenderness or percussion pain, no breakage or loosening of internal fixation, no varus calcaneus tuberosity, no subtalar joint fusion, and no compression symptoms of peroneal tendons. Achilles tendon irritation occurred in 2 cases, and disappeared after removal of internal fixation; traumatic arthritis occurred in 2 cases, and was relieved after removal of internal fixation. The Böhler angle, Gissane angle, and calcaneal width were significantly improved at 3 days and 6 months after operation when compared with preoperative ones ( P<0.05). The loss of the above indexes was observed at 6 months, showing no significant difference between at 3 days and 6 months ( P>0.05). The AOFAS score results were excellent in 11 cases, good in 3 cases, and fair in 2 cases, and the excellent and good rate was 87.5%. Conclusion It has the advantages of little trauma, less complication, and good function recovery to use arthroscopically-assited closed reduction and percutaneous screw fixation by posterior approach to subtalar joint for calcaneal fractures of Essex-Lopresti tongue type, Sanders IIA, Sanders IIB, and Sanders IIIAB.
Collapse
Affiliation(s)
- Fu Dong
- Department of Orthopaedics, Beihai People's Hospital of Guangxi Province, Beihai Guangxi, 536000, P.R.China
| | - Chun Lu
- Department of Orthopaedics, Beihai People's Hospital of Guangxi Province, Beihai Guangxi, 536000, P.R.China
| | - Jinrong Zhu
- Department of Orthopaedics, Beihai People's Hospital of Guangxi Province, Beihai Guangxi, 536000, P.R.China
| | - Yunfeng Li
- Department of Orthopaedics, Beihai People's Hospital of Guangxi Province, Beihai Guangxi, 536000, P.R.China
| | - Kun Mi
- The Second Department of Orthopaedics, the First Affiliated Hospital, University of Guangxi Traditional Chinese Medicine, Nanning Guangxi, 530000,
| |
Collapse
|
48
|
Zou W, Xiao J, Long H, He H, Wu C, Feng M, Zhou C. [Design and clinical application of a new extracorporeal reduction device for percutaneous pedicle screw fixation in treatment of thoracolumbar fractures]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2017; 31:66-72. [PMID: 29798632 DOI: 10.7507/1002-1892.201608117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To design a new extracorporeal reduction device for percutaneous pedicle screw fixation of thoracolumbar fractures (short for "new reduction device"), and to evaluate its effectiveness. Methods According to the mechanism of thoracolumbar fractures and biomechanics characteristic of reduction, a new reduction device was designed and used in a combination with long U-shaped hollow pedicle screw system. Between January 2014 and January 2016, 36 patients (group A) with single segment thoracolumbar fracture without neurological complications underwent percutaneous pedicle screw fixation, and the clinical data were compared with those of another 39 patients (group B) with thoracolumbar fracture underwent traditional open pedicle screw fixation. There was no significant difference in gender, age, cause of injury, classification of fractures, segments of fractures, injury to operation interval, height percentage of injury vertebrae, and kyphotic angle between 2 groups ( P>0.05). The 2 groups were compared in terms of operation time, length of incision, intraoperative blood loss, drainage volume, visual analogue scale (VAS) at postoperative 24 hours, fluoroscopy frequency, ambulation time, height percentage of injury vertebrae, kyphotic angle and correction. Results Group A was significantly better than group B in the operation time, length of incision, intraoperative blood loss, drainage volume, VAS score at postoperative 24 hours, and ambulation time ( P<0.05). However, fluoroscopy frequency of group B was significantly less than that of group A ( P<0.05). All patients were followed up 11.2 months on average (range, 7-15 months). There was no intraoperative and postoperative complications of iatrogenic nerve injury, infection, breakage of internal fixation. Mild pulling-out of pedicle screws occurred in 1 case of group A during operation. The kyphotic angle and height percentage of the fractured vertebral body were significantly improved at 3 days after operation when compared with preoperative ones ( P<0.05), but no significant difference was found between 2 groups at 3 days after operation ( P>0.05). Conclusion Minimally invasive extracorporeal reduction device for percutaneous pedicle screw fixation is an effective and safe treatment of thoracic vertebrae and lumbar vertebrae fractures, because of little trauma, less bleeding, and quicker recovery.
Collapse
Affiliation(s)
- Wei Zou
- Department of Spine Surgery, the Fourth People's Hospital of Guiyang, Guiyang Guizhou, 550002,
| | - Jie Xiao
- Department of Spine Surgery, the Fourth People's Hospital of Guiyang, Guiyang Guizhou, 550002, P.R.China
| | - Hao Long
- Department of Spine Surgery, the Fourth People's Hospital of Guiyang, Guiyang Guizhou, 550002, P.R.China
| | - Hui He
- Department of Spine Surgery, the Fourth People's Hospital of Guiyang, Guiyang Guizhou, 550002, P.R.China
| | - Chen Wu
- Department of Spine Surgery, the Fourth People's Hospital of Guiyang, Guiyang Guizhou, 550002, P.R.China
| | - Mingxing Feng
- Department of Spine Surgery, the Fourth People's Hospital of Guiyang, Guiyang Guizhou, 550002, P.R.China
| | - Changjun Zhou
- Department of Spine Surgery, the Fourth People's Hospital of Guiyang, Guiyang Guizhou, 550002, P.R.China
| |
Collapse
|
49
|
Abstract
BACKGROUND Transfer of a flexor hallucis longus (FHL) tendon can not only reconstruct the Achilles tendon but also provide ischemic tendinous tissues with a rich blood supply to enhance wound healing. This retrospective study aims to investigate clinical outcomes in patients who underwent repair of Kuwada grade IV chronic Achilles tendon rupture with long hallucis longus tendons harvested using a minimally invasive technique. MATERIALS AND METHODS 35 patients who were treated for Kuwada grade IV Achilles tendon injuries from July 2006 to June 2011 were included in this retrospective study. The age ranged between 23 and 71 years. The duration from primary injury to surgery ranged from 29 days to 34 months (mean value, 137.6 days). All 35 patients had difficulties in lifting their calves. Thirty two were followed up for a mean 32.2 months (range 18-72 months), whereas three were lost to followup. Magnetic resonance imaging (MRI) showed that the tendon rupture gap ranged from 6.0 to 9.2 cm. During surgery, a 2.0 cm minor incision was made vertically in the medial plantar side of the midfoot, and a 1.5 cm minor transverse incision was made in the plantar side of the interphalangeal articulation of the great toe to harvest the FHL tendon, and the tendon was fixed to the calcaneus with suture anchors. Postoperative appearance and function were evaluated by physiotherapists based American Orthopedic Foot and Ankle Society-ankle and hindfoot score (AOFAS-AH), and Leppilahti Achilles tendon ratings. RESULTS Results were assessed in 32 patients. Except for one patient who suffered complications because of wound disruption 10 days after the operation, all other patients had primary wound healing, with 28 of 32 able to go up on their toes at last followup. The AOFAS-AH score was increased from preoperative (51.92 ± 7.08) points to (92.56 ± 6.71) points; Leppilahti Achilles tendon score was increased from preoperative (72.56 ± 7.43) to (92.58 ± 5.1). There were statistically significant differences. The result of the total excellent and good rate was 93.8% (30/32). MRI of Achilles tendon showed even signal without evidence of tear or cystic degeneration. CONCLUSION Reconstruction of a chronic Achilles tendon rupture with an FHL tendon harvested using a minimally invasive technique showed good outcomes.
Collapse
Affiliation(s)
- Xudong Miao
- Department of Orthopaedics, Institute of Orthopaedic Research, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, P. R. China
| | - Yongping Wu
- Department of Orthopaedics, Institute of Orthopaedic Research, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, P. R. China
| | - Huimin Tao
- Department of Orthopaedics, Institute of Orthopaedic Research, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, P. R. China
| | - Disheng Yang
- Department of Orthopaedics, Institute of Orthopaedic Research, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, P. R. China
| | - Lu Huang
- Department of Orthopaedics, Institute of Orthopaedic Research, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, P. R. China,Address for correspondence: Dr. Lu Huang, Department of Orthopaedics, Institute of Orthopaedic Research, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, P.R. China. E-mail:
| |
Collapse
|
50
|
Zhang T, Wang X, Zhao L, Liu F, Chen H, Deng X, Peng C, Shen B. Transperitoneal robotic resection of benign primary retroperitoneal tumors: can it be widely used? Int J Med Robot 2015. [PMID: 26202698 DOI: 10.1002/rcs.1689] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND This article was aimed to show the safety, flexibility and other advantages of transperitoneal robot-assisted resection of benign primary retroperitoneal tumors. METHODS Ten patients underwent robotic surgeries, and 31 underwent laparotomy surgeries from 2012 to 2014. The perioperative data, including tumor size, operation time, and other parameters were analyzed. RESULTS The tumor sizes of the two groups were not different (robotic group vs laparotomy group: 5.47 vs 5.32 cm, respectively; P = 0.777). The differences in the blood loss (robotic group vs laparotomy group: 80.00 vs. 146.08 mL, respectively; P = 0.021), time of oral intake (robotic group vs laparotomy group: 2.12 vs. 3.42 d, respectively; P = 0.045) and post-operation hospital stay (robotic group vs laparotomy group: 5.40 vs. 8.77 d, respectively; P = 0.004) were statistically significant and lower in the robotic group. CONCLUSION Robot-assisted resection of benign retroperitoneal tumors is flexible and safe and provides better protection when complex lesions are removed. Copyright © 2015 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Tian Zhang
- Department of General Surgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Xinjing Wang
- Department of General Surgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Liangchao Zhao
- Department of General Surgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Fei Liu
- Department of General Surgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Hao Chen
- Department of General Surgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Xiaxing Deng
- Department of General Surgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Chenghong Peng
- Department of General Surgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Baiyong Shen
- Department of General Surgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| |
Collapse
|